Answers to frequently asked questions relating to the 2025/26 NHS Payment Scheme (NHSPS) are set out below. Please contact england.pricingenquiries@nhs.net if you have further questions.

Q: For activity paid on a variable basis, what data should be used for provider payments?

For activity paid on a variable basis, where reconciliation may be required, providers should be paid using quarterly freeze data. This is described in Section 46 of the technical guidance for the 2025/26 NHS Standard Contract.

Q: Should optical coherence tomography (OCT) scans be paid for separately to an outpatient ophthalmology attendance?

No – the NHSPS guidance explains that they should not be paid separately (see Annex B). This is because:

• Optical coherence tomography (OCT) scans should be submitted to SUS PbR as part of the outpatient attendance record. That record will group to the procedure-driven HRG, BZ88A, which has an outpatient procedure unit price and is therefore a procedure-driven HRG that is covered by an aligned payment and incentive agreement.
• A scan will not necessarily take place on the same day as an outpatient attendance, however under the NHS Payment Scheme and the rules for submitting to SUS, the scan is part of the attendance.
• If there is more than one outpatient attendance on the day the scan was requested, and if local systems do not allow identification of which attendance the scan was requested from, follow these steps:
  • If the diagnostic imaging occurs on the same day as the outpatient activity, and there is more than one outpatient attendance, the scan should be assumed to be related to the activity it follows, using time to establish the order of events.
  • If the scan occurs before any outpatient activity on that day, it should be assumed to be related to the first outpatient attendance that day.
  • If the diagnostic imaging occurs on a different day from the outpatient activity, the scan can be assumed to be related to the first attendance on the day the scan was requested.

For more details, see Annex B: Guidance on currencies, Section 4 Diagnostic imaging (paragraphs 71-74).