Prescribed Specialised Services (PSO) Tool 2026/27 Update

NHS England has decided to postpone the release of the EWG, clinically-endorsed, HRG4+ 2026/27 Local Payment Grouper and HRG design to better allow financial volatility management given the magnitude of the change. 

This has also resulted in the Prescribed Specialised Services 2026/27 Operational Tool being postponed.

NHS England Specialised Commissioning Team have however, requested that the Identification Rules be updated for use in 2026/27. These changes will be implemented in SUS.

Therefore, the National Casemix Office have been commissioned by NHS England Specialised Commissioning Team to create an updated Prescribed Specialised Services 2025/26 Operational Tool v2 which incorporates changes to the identification rules only.

Please note that this Tool will have to be used with the Pricing Mapping TOCE as it has not been updated to accommodate OPCS 4.11 and changes to coding standards.

It is expected that the Prescribed Specialised Services 2025/26 Operational Tool v2 will be available in May and will be published here  Prescribed Specialised Services (PSO) Tool 2025/26. 

 

Further information

Update - 10 April 2026

The following update was published on the Secondary Uses Service what's new - NHS England page on the 10 April 2026:

2026/27 SUS+, OPCSv4.11 and HRG Grouping – Update

A table for Office of Population Censuses and Surveys Classification of Interventions and Procedures (OPCS) 4.11 to OPCS 4.10 mapping for pricing equivalence is available below.   It is a one-to-one mapping of new and retired codes created by the NHS England Pricing team.  This table is not the same as the coding equivalence table published in clinical coding guidance which includes mappings from 4.11 to combinations of 4.10 codes.  The purpose of this table is to produce Healthcare Resource Groups (HRGs) from new 4.11 codes using the 25/26 grouping logic such that these HRGs will work with the published NHS National Payment Scheme prices.

SUS+ is commissioning a modified 25/26 AutoGrouper that will incorporate this table.  OPCS 4.11 codes will be accepted as input, translated within the AutoGrouper to an equivalent OPCS 4.10 code before derivation of HRGs for use with the published prices.  Results of the code mapping and substitution will be made available in data extracts from SUS+.

The table is provided should users wish to create their own mapping process to adjust their local input to the current standalone 25/26 Local Payment Grouper produced by the National Casemix Office.  Please note that presenting OPCS 4.11 codes to a 25/26 grouper without first applying the translation will result in a UZ01Z (Invalid for grouping) HRG as these new codes are not recognised by that logic.  It should also be noted that using the map means the inputs to the grouper are OPCS 4.10 codes, and in some instances the dominant grouping procedure returned will be the mapped code, not the original 4.11 code.

The link to the mapping table is opcs_411_410_autogrouper_pricing_toce

Update - 1 April 2026

The following information was published in the 2026/27 NHS Payment Scheme: 

NHS England » 2026/27 NHS Payment Scheme

From 1 April 2026, a new edition (v4.11) of OPCS procedure codes will be introduced. The national reimbursement system will be updated to reflect these new codes. A table of coding equivalence (TOCE) will be made available to providers and commissioners, who can use it in conjunction with the HRG4+ 2025/26 Local Payment Grouper. However, this may not take into account changes in coding practice. Where there is a significant impact as a result, changes should be neutralised using the counting and coding provisions in the NHS Standard Contract. NHS England will issue separate guidance on the treatment of ungrouped activity arising from OPCS-4.11 codes prior to the TOCE being available for reimbursement purposes.

Update - 1 April 2026

The following information was published in the 2026/27 NHS Payment Scheme: 

NHS England » 2026/27 NHS Payment Scheme

From 1 April 2026, a new edition (v4.11) of OPCS procedure codes will be introduced. The national reimbursement system will be updated to reflect these new codes. A table of coding equivalence (TOCE) will be made available to providers and commissioners, who can use it in conjunction with the HRG4+ 2025/26 Local Payment Grouper. However, this may not take into account changes in coding practice. Where there is a significant impact as a result, changes should be neutralised using the counting and coding provisions in the NHS Standard Contract. NHS England will issue separate guidance on the treatment of ungrouped activity arising from OPCS-4.11 codes prior to the TOCE being available for reimbursement purposes.

1 April 2026

The OPCS-4 Classification of Interventions and Procedures is a mandatory information standard used for the clinical coding of hospital interventions and procedures undertaken by the NHS.  It supports analysis of healthcare data across the NHS.

The latest Information Standards Notice DAPB0084: OPCS Classification of Interventions and Procedures - NHS England Digital was approved by the Data Assurance Board on 29 October 2025, for England implementation and full conformance date on 1 April 2026

The scope of the standard covers all Health Care Providers that are required to submit data on interventions and procedures for the Admitted Patient Care Commissioning Data Sets (CDS), with details available in the OPCS-4.11 Requirements Specification.  The requirements for Heath Care Providers as stipulated in the Requirements Specification include:

• All Care Professional Admitted Care Episodes and day cases that contain interventions/operations MUST be recorded to OPCS-4.11 on or after 1 April 2026 and until further notice to support mandatory data collections including Admitted Patient Care Commissioning Data Sets (CDS), other Central Returns and data collections
• All Health Care Providers that are required to submit interventions/operations for Admitted Patient Care Commissioning Data Sets (CDS), Central Returns for secondary uses as well as a number of other data collections MUST implement the updates in readiness for implementation on 1 April 2026.
• Health Care Providers MUST apply OPCS-4.11 to all applicable Care Professional Admitted Care Episodes that finish on or after 1 April 2026.

The above information confirms that providers in England must implement and flow OPCS-4.11 from 1 April 2026 to comply with Section 250 of the Health and Social Care Act 2012.