NHS England has carefully considered the feedback received to the consultation on the proposals for the 2026/27 NHS Payment Scheme (NHSPS). This document describes the corrections, clarifications and changes made to the proposals consulted on for the final 2026/27 NHSPS.
Please note: The pay cost estimates used to set the NHSPS cost uplift factor for 2026/27 do not reflect final pay arrangements, which have not yet all been agreed. When all pay awards have been finalised, we will revise the cost uplift factor and publish a revised Annex A with updated prices. Once published, the updated prices and cost uplift factor should be backdated to 1 April 2026.
The key changes for the final 2026/27 NHSPS are as follows:
- We have decided to classify the proposed unit price for same day emergency care (SDEC) as a guide price. SDEC activity will continue to form part of the urgent and emergency care (UEC) blended payment and providers and commissioners will be required to agree local SDEC prices, informed by the guide price where appropriate.
- We have added additional guidance on patient-not-present (PNP) payments (see section 3.5 of Annex B). The PNP payments should be implemented by 1 July 2026.
- We have revised the radiotherapy blended payment model for 2026/27 to ensure providers do not lose out by moving to SABR/hypofractionation.
- We have clarified the payment arrangements for drugs delivered as homecare where items have been removed from the high cost exclusion list, with funding moved into prices. Tab 12.1b of the consultation Annex DpA contained information about drugs removed from the excluded items list. This tab has been removed from the final Annex A, however more information about the change in drugs is available from the Payment system support Futures workspace.
- In the consultation responses, there were concerns from independent sector providers about the proposed changes to ophthalmology prices. We have considered the points raised, but feel that it is appropriate to continue with the changes to encourage more ophthalmology activity in services that currently have longer waiting lists than for cataracts. The proposed changes were also generally supported by ICBs and by NHS providers. By introducing the price changes at the start of the year, rather than in-year as was initially considered as part of the amendment consultation on the 2025/26 NHSPS, providers and commissioners should be able to incorporate the revised prices in their plans for the year ahead.
As the 2026/27 NHS Standard Contract was published before the 2026/27 NHS Payment Scheme, Schedule 3 of the contract (relating to payment) directs users to the Payment Scheme for guidance on completing the schedule. Detailed guidance on completing the Aligned payment and incentive sections of the Contract schedule have been added to Section 2.11 of the NHS provider payment mechanisms document.
We received a very large number of consultation responses from individuals relating to the proposals to introduce guide prices for ADHD and autism services. While many of the issues raised were not directly relevant to the payment proposals, we have discussed the feedback within NHS England, and with ICBs, finance colleagues, clinical experts and both NHS and independent sector providers. Following consideration of the issues raised in the consultation feedback from individuals, providers, ICBs and others, we have decided to make some increases to the guide prices for ADHD and autism assessments, outlined below. We have also updated the ADHD and autism payment guidance to address areas of potential confusion and clarify the role of guide prices.
| Guide price consulted on | Guide price in final NHSPS | |
| ADHD | ||
| Adult – ADHD Assessment – Face-to-Face | 800 | 850 |
| Adult – ADHD Assessment – Virtual | 600 | 700 |
| CYP – ADHD Assessment – Face-to-Face | 900 | 950 |
| Autism | ||
| Adult – Autism Assessment – Face-to-Face | 950 | 1,150 |
| CYP – Autism Assessment – Face-to-Face | 950 | 1,350 |
| Combined ADHD and Autism | ||
| Adult – Combined ADHD/Autism Assessment – Face-to-Face | 1,100 | 1,300 |
| CYP – Combined ADHD/Autism Assessment – Face-to-Face | 1,200 | 1,500 |
All substantive changes are detailed in the table below. There have also been minor editorial changes to improve clarity, consistency and accuracy. For more information, please contact england.pricingenquiries@nhs.net.
| Location | Issue | Change | Correction, clarification or policy change? |
| NHS Payment Scheme, Section 1 (Introduction) | Lack of clarity on potential impact of introduction of new edition of OPCS procedure codes. | Add new paragraph to highlight introduction of OPCS 4.11, and potential need to use Standard Contract counting and coding provisions to neutralise impact. | Clarification |
| NHS Payment Scheme, Section 2.8 (Commercial research) | Unclear how NHSPS relates to commercial research activity. | Add Section 2.8 to make clear that commercial research is outside of scope of NHSPS, signposting where additional information from NIHR can be obtained to support commercial income and payment. | Clarification |
| NHS Payment Scheme, Section 3.2 (Cost uplifts), paragraph 69 | Process for updating cost uplift factor and prices to reflect final pay awards unclear. | Confirm that cost uplift factor and prices will be updated and reissued as part of the NHSPS once final 2026/27 pay awards are confirmed. | Clarification |
| NHS Payment Scheme, Section 3.4 (Excluded items), paragraph 75 | Uncertainty about payment arrangements for drugs that have moved from the excluded items list and are delivered as homecare services. | Clarify that all funding for the drugs has moved into prices and drugs delivered as homecare are paid either by prices or via local arrangements. | Clarification |
| NHS Payment Scheme, Section 3.5 (Terms used in payment mechanism rules), paragraph 80 | Confusion about whether specialised services commissioned by NHS England are included in the urgent and emergency care (UEC) blended payment. | Remove bullet stating that specialised services are not included within the definition of ‘emergency care services’. | Correction |
| NHS Payment Scheme, Section 3.5 (Terms used in payment mechanism rules), paragraph 80 | Confusion about scope of same day emergency care (SDEC) activity. | Added bullet point to define specialty SDEC and other same day emergency care pathways. | Clarification |
| NHS Payment Scheme, Section 4 (API rules), rule 2.e)i) | Decision that patient-not-present (PNP) payments should be implemented by 1 July, rather than from 1 April. | Updated rule so PNP implementation is by 1 July. | Policy change |
| NHS Payment Scheme, Section 4 (API rules), rule 2.e)iii) | Decision, following consultation feedback, to change specialty SDEC price from unit to guide. | Update rules to refer to specialty SDEC guide price and make clear that providers and commissioners need use locally agreed prices in the blended payment. | Policy change |
| NHS Payment Scheme, Section 4 (API rules), rule 2.e)iv) | Decision, following consultation feedback, to allow transitional arrangements as part of radiotherapy blended payment model. | Update rules to include transitional arrangements to support providers significantly affected by the move to blended payment. | Policy change |
| NHS Payment Scheme, Section 5 (LVA rules), rule 3.a)ii) | Confusion about scope of LVA exclusion of out-of-area placements into mental health services. | Clarify that placements need to be directly requested by the patient’s commissioner. | Clarification |
| NHS Payment Scheme, Section 8.2 (The market forces factor), paragraphs 106 and 108 | Confusion about which MFF value to be used for independent sector providers delivering remote/virtual services. | Signpost to MFF guidance document that provides more detailed guidance on which MFF value should be used. | Clarification |
| Annex A: 2026/27 prices workbook – tabs 1 APC & OPROC and 5a BPT Prices | Decision to change compliance rates for some day case BPTs following consultation feedback. | Update to some day case BPT prices and to OPROC prices for MA10Z and MA12Z, which are set to the day case BPT price. | Correction |
| Annex A: 2026/27 prices workbook – tab 4a CDC unit prices, Section 4. Pathology | Separate prices needed for split blood test (Phlebotomy) CDC currency between adult and paediatric. | Separate prices set. | Policy change |
| Annex A: 2026/27 prices workbook – tab 4a CDC unit prices | Serological Assay (Gastropanel) should be in Pathology, not Endoscopy. | Move Serological Assay (Gastropanel) from Endoscopy section to Pathology. | Correction |
| Annex A: 2026/27 prices workbook – tab 4a CDC unit prices | Endoscopy test name and description should be ‘Digital Proctoscopy or Digital Rectal’, not ‘Digital Proctoscopy’. | Change Endoscopy test name and description from ‘Digital Proctoscopy’ to ‘Digital Proctoscopy or Digital Rectal’. | Correction |
| Annex A: 2026/27 prices workbook – tab 4b Genomics prices | Update to some genomics medicine services prices following consultation feedback and work with NHS England Specialised Commissioning. | Set rare disease report prices to cancer report prices for next generation sequencing panel TMCs 21, 22, 23. Set rare disease report price for test method, whole exome sequencing – proband, within TMC12, to price for large next generation sequencing panel. Remove (do not set) rare disease report price for test method, whole exome sequencing plus multiplex ligation-dependent probe amplification, within TMC12. | Policy change |
| Annex A: 2026/27 prices workbook – tab 4c Other unit prices | The price for DZ32Z was incorrect in Direct access services. | Amend price of direct access HRG DZ32Z to equal the CDC price. | Correction |
| Annex A: 2026/27 prices workbook – tab 5a BPT prices | Sleep apnoea BPT not providing sufficient incentive. | Update BPT price to £541. | Correction |
| Annex A: 2026/27 prices workbook – tab 5a BPT prices | The price for RD30Z incorrectly identified for eligible BPT. | Changed HRG to the core HRG WF02B, with unbundled HRG RD30Z included among the required criteria for Dysphagia RTT HRG WF02B on tab 5b BPT flags. | Correction |
| Annex A: 2026/27 prices workbook – tab 5a BPT prices | Unbundled activity not being paid separately on OPROC HRGs. | Amend BPT price for haematuria and Lower Urinary Tract Symptoms. | Correction |
| Annex A: 2026/27 prices workbook – tab 5a BPT prices | Errors in prices for unilateral hearing loss/tinnitus and audiology (HRG CA37A, CA43Z). | Changed level from sub-HRG to HRG; non-BPT prices set to the OPROC prices. | Correction |
| Annex A: 2026/27 prices workbook – tab 5b BPT flags | Errors identified in criteria for the Dysphagia RTT. | Criteria for the Dysphagia RTT split into 3 rows since different OPCS codes apply to different HRGs. Text amended to refer to the intended lists in each case. A core HRG WF02B specified for where the unbundled HRG RD30Z is among the required criteria. List of OPCS codes for RD30Z has been removed as the criteria applies at sub HRG level and not at sub-unbundled HRG level. | Correction |
| Annex A: 2026/27 prices workbook – tab 5c BPT flag code list | OPCS codes M657, G164 and G455 not included in the RTT list. | Codes added to the list. | Clarification |
| Annex A: 2026/27 prices workbook – tab 6 A&E & SDEC; 8 Other guide prices | Decision to make same day emergency care (SDEC) price a guide price rather than a unit price. | Move SDEC price to tab 8 (guide prices); amend name of tab 6 to ‘6 A&E’. | Policy change |
| Annex A: 2026/27 prices workbook – tab 7a Maternity prices | Error in not updating all maternity prices to include CNST. | Updated all maternity prices to include CNST uplift, rather than just subchapter NZ prices. | Correction |
| Annex A: 2026/27 prices workbook – tab 7a Maternity prices | Non-delivery admitted patient and outpatient procedure guide prices for maternity services did not include non-elective spell prices in the table headings. | Update text to include non-elective spell prices in the table headings. | Correction |
| Annex A: 2026/27 prices workbook – tab 7a Maternity prices | All maternity prices listed as unit prices, rather than guide prices. | Update classification to guide prices. | Correction |
| Annex A: 2026/27 prices workbook – tab 8 Guide prices | Text suggested incorrectly that 2023/24 cost data was used to calculate Neonatal critical care guide prices. | Changed text to make clear that cost data from 2017/18 was used to calculate prices. | Correction |
| Annex A: 2026/27 prices workbook – tab 8 Guide prices | Following consideration of consultation feedback, decision made to increase assessment prices. | Updates made to ADHD and autism assessment prices. | Policy change |
| Annex A: 2026/27 prices workbook – tab 9 Service clarification | Confusion about services covered by unit prices. | Update clarification of services covered by unit prices: homecare service delivery clarification (row 16); cell F14 – refer to published critical care guide prices; cell F41 – refer to published rehabilitation unit/guide prices. | Clarification |
| Annex A: 2026/27 prices workbook – tab 12a HC devices | Lack of clarity about Intracranial Telemetry in the Listed Procedures and Tests sections. | Removed Intracranial Telemetry text as non-priced HRGs exist, update text regarding cancer genetic tests reimbursed by NHSPS prices. | Clarification |
| Annex A: 2026/27 prices workbook – tab 13b PSS provider payment values | Text referred to ‘floor values’ rather than ‘fixed values’. | Remove reference to floor values. | Correction |
| Annex A: 2026/27 prices workbook – tab 14a HRG Based Price Type | Some prices for CDC and Direct Access settings not included. | Update table in sheet to indicate additional price points for CDC and Direct Access settings for some currencies with APC/OPROC prices. | Clarification |
| Annex B, Guidance on currencies, Section 2.2 (termination of pregnancy), paragraphs 28-20 | Confusion about which prices should be paid for services and if providers should be reimbursed for all activities separately. | Update to confirm that pricing agreements should take account of the prices for all activities provided. | Clarification |
| Annex B, Guidance on currencies, Section 3.5 (patient-not-present payments) | Lack of clarity what qualifies for the patient-not-present payment and how they will be implemented. It has also been decided to include RTT status code 30 (first definitive treatment) from the scope of PNP, but to exclude code 36 (patient died before treatment). | New section added to clarify PNP criteria and operation. | Clarification |
| Annex B, Guidance on currencies, Section 5.2.1 (Development of radiotherapy services) | Text does not reflect changes to radiotherapy blended payment to allow transitional flexibility or give description of SABR for prostate price. | Add new paragraphs to give details of the transitional flexibility (102) and add description of SABR for prostate (105). | Policy change |
| Annex B, Guidance on currencies, Section 13 (A&E services) and 15 (Same day emergency care) | Guide price set for specialty SDEC so new section needed. | Section 15 added to give information about specialty SDEC. | Policy change |
| Annex B, Guidance on currencies, Section 14 (Maternity pathways) | Maternity prices should be guide prices. | References to maternity unit prices removed. | Correction |
| Annex C, Guidance on BPTs, Section 9 (Acute stroke care) | References to clinical guidelines out of date. | Updated to refer to latest clinical guidelines. | Correction |
| Annex C, Guidance on BPTs, Section 8.2 (Sleep apnoea) | OPCS and HRG for the BPT have been confirmed. | Update text to remove disclaimer about potential change for OPCS 4.11. | Clarification |
| Annex C, Guidance on BPTs, Section 8.3 (Transnasal oesophagoscopy) | “Intermediate Therapeutic Endoscopic, Upper or Lower Gastrointestinal Tract Procedures, 19 years and over” included in error. | Text removed from bullet point. | Correction |
| Annex C, Guidance on BPTs, Section 8.3 (Transnasal oesophagoscopy) | OPCS 4.11 has updated codes. | Add “OR G16.4_Diagnostic fibreoptic endoscopic ultrasound examination of oesophagus and biopsy of lesion of oesophagus” added to para 141 bullet points. | Correction |
| Annex C, Guidance on BPTs, Section 8.4 and 8.5 (Haematuria and Lower Urinary Tract Symptoms) | Potential confusion about unbundled HRGs. | Update each section to confirm that there is no separate unbundled HRG payment when the criteria for the BPT price are met. | Clarification |
| Annex C, Guidance on BPTs, Section 8.5 (Lower Urinary Tract Symptoms) | Diagnostic imaging should be included in unit prices. | Update text to clarify that diagnostic imaging paid as part of prices. | Clarification |
| Annex C, Guidance on BPTs, Section 8.6 (Unilateral hearing loss/tinnitus) | Unclear if BPT applies to all activity in HRGs. | Remove text that suggests BPT would not apply to some activity. | Clarification |
| Annex C, Guidance on BPTs, Section 8.6 and 8.7 (Unilateral hearing loss/tinnitus and Dysphagia) | Unclear if BPT only applies where activity recorded as part of a single spell. | Clarify that BPT applies for activity recorded in outpatient setting and meeting the BPT criteria. | Clarification |
| Annex C, Guidance on BPTs, Section 8.7 (Dysphagia) | RD30Z should be a qualifier rather than a primary procedure. | Remove RD30Z from list of primary procedures and confirm this is a qualifier and unbundled HRG for primary procedure code WF02B. | Clarification |
| Annex C, Guidance on BPTs, Section 8.7 (Dysphagia) | OPCS 4.11 has updated codes. | “OR G455_Fibreoptic endoscopic ultrasound examination of upper gastrointestinal tract and biopsy of lesion of upper gastrointestinal tract” added to 2 sub-bullet points in para 161. | Correction |
| Annex D, Prices and cost adjustments, Section 1 (Introduction) | The table describing the role of prices did not reflect the role of unit prices in API blended payments. | Update the table to clarify role of unit prices. | Correction |
| Annex D, Prices and cost adjustments, Section 2.7 and 2.8 (2026/27 and 2027/28) | SDEC price moving from unit price to guide price. | Move content on SDEC from Section 2.7 to Section 2.8. | Policy change |
| Annex D, Prices and cost adjustments, Section 3 (Cost uplift factor) | Not clear how revision of cost uplift factor to reflect final pay awards would be implemented. | Add paragraph (70) to make clear that revised CUF and Annex A will be issued. | Clarification |
| Annex D, Prices and cost adjustments, Appendix 2 (Cash in/cash out adjustments) | Reference to consultation worksheet ‘12b.1 HC drugs removal’ for details of money moving as a result of drugs being taken off excluded items list, but this worksheet not being published as part of final NHSPS. | Update reference to drugs and devices information on Futures workspace and add in details of the amount being moved. | Clarification |
| Supporting document, NHS provider payment mechanisms | Need to update to align with changes described above. | Changes made: Section 2.6 (Excluded items) – description of homecare funding for drugs removed from excluded list.Section 2.11 (API arrangements and the NHS Standard Contract) – section added to describe requirements for Schedule 3A of the Contract.Section 5.1 (UEC blended payment) – clarified operation of the 20% variable rate and give details of specialty SDEC guide price.Section 5.2 (radiotherapy) – added details of transitional flexibility and description of SABR for prostate price.Section 6.2 (LVA – scope) – clarify scope of exception for placements into mental health services.Appendix 2 added to provide a worked example of the UEC blended payment. | Policy change and clarification |
| Supporting document, ADHD and autism payment guidance | Consultation feedback highlighted some areas where the guidance needed to be strengthened. It was also decided to increase the guide prices. | Changes to document to: Reflect updated prices.Clarify definition of ‘guide price’, as a non-mandated benchmark, and that prices are based on an average so varied patient need may need to be reflected in local pricing.Clarify that the titration is based on an average of three appointments, but local agreement may be needed for more complex cohorts that require additional necessary appointments.Emphasise joined-up approach to combined assessments (especially for children and young people).Clarify approach to did-not attend (DNAs), reviews, private pharmacy, triage and when in the pathway payment would be due. | Policy change and clarification |