Effective October 1, 2026, ICD-10-PCS code XEZU3HC establishes the first dedicated national inpatient coding category for real-time ultrasound navigation with continuous needle tracking.
CHARLOTTESVILLE, VA, SEPTEMBER 17, 2026: RIVANNA®, developer of AI-enabled clinical decision-support solutions, today announced that the Centers for Medicare & Medicaid Services (CMS) has established ICD-10-PCS code XEZU3HC, effective for inpatient discharges beginning October 1, 2026. The code identifies computer-aided intraprocedural navigation in the spinal canal using ultrasound imaging with continuous needle tracking via a percutaneous approach during neuraxial anesthesia.
Before XEZU3HC, use of diagnostic ultrasound navigation during neuraxial anesthesia was not separately reportable in inpatient hospital coding. Facilities could report the underlying neuraxial anesthesia under existing codes, but the navigation itself left no trace in the record. The new code changes what that record can show: a standardized way to identify coded use and track adoption, and, when linked with clinical and operational data, a basis for evaluating outcomes.
Unintended dural puncture occurs in 0.5% to 1.5% of labor epidural placements (Van de Velde 2008; Choi 2003), and the United States has no dedicated mandatory national reporting system for it. The consequences are not always brief: in a prospective multicenter cohort study that enrolled 90 patients with accidental dural puncture and 180 matched controls, 58% of those who experienced accidental dural puncture still had persistent headache at 18 months, compared with 17% of controls (Niraj 2021).
Accuro® 3S brings ultrasound guidance into the placement itself. It is the first FDA-cleared, AI-enabled, real-time ultrasound guidance system purpose-built for neuraxial anesthesia. The system combines automated anatomical guidance through SpineNav-AI™, midline needle access through the patented Dual-Array™ probe’s central aperture, and real-time needle-tip tracking through SafeTrack™. CMS recognized the technology as procedurally distinct. Beginning October 1, XEZU3HC makes this form of guidance identifiable in inpatient data.
“Accuro 3S was developed to bring real-time guidance to neuraxial procedures,” said Will Mauldin, PhD, Co-founder and CEO of RIVANNA. “With XEZU3HC, that procedural shift will no longer be invisible in inpatient data. The code does not prove benefit; it gives hospitals a standardized way to identify use and, when linked with clinical data, evaluate outcomes.”
CMS placed XEZU3HC in Section X, New Technology, under the newly created XEZ table. The code applies to a procedural category, not to a specific company or product, and does not by itself establish separate payment. What it establishes is identification: a standardized data structure that can support evaluation of the clinical and economic impact of computer-aided neuraxial guidance across institutions.
“Neuraxial procedures are still performed largely by feel, and the complications that follow have been difficult to see in national data,” said Delphine Le Roux, PhD, PMP, Senior Director, Market Access and Strategic Partnerships at RIVANNA. “That was the case we brought to CMS: real-time guidance changes the procedure enough that it needs its own identifier. Coding, evidence, and reimbursement follow a sequence, and this is the first step. Real-world data can then help evaluate the clinical and economic value of navigation and inform future payment discussions.”
Beginning in the fourth quarter of 2026, RIVANNA plans to include XEZU3HC, where assigned by participating facilities, in its outcomes framework alongside procedural and workflow data.
About Accuro 3S
Accuro 3S is a portable, cart-based, point-of-care diagnostic ultrasound system featuring the patented Dual-Array probe, automated anatomical guidance through SpineNav-AI, and real-time needle-tip tracking through SafeTrack. Two transducer arrays flank a central aperture through which the needle can be introduced and advanced along the spinal midline within the ultrasound imaging plane. SpineNav-AI automatically identifies lumbar spinal landmarks and midline and measures depth to the epidural space in real time. When used with a compatible tracked needle, SafeTrack displays needle-tip location and trajectory relative to the ultrasound image in real time.
Accuro 3S extends the clinical foundation established by the flagship Accuro platform. In a randomized trial of 80 obese parturients undergoing elective cesarean delivery with combined spinal-epidural anesthesia, first-insertion success was 72.5% with Accuro and 40.0% with palpation (p=0.003; Ni 2021). The published evidence pertains to the flagship Accuro platform; Accuro 3S-specific outcomes will be tracked through RIVANNA’s outcomes framework.
About RIVANNA
RIVANNA is a medical technology company developing clinical decision-support solutions powered by proprietary clinical datasets, AI models, and purpose-built imaging hardware. The company’s platform is designed to automate complex anatomical analysis at the point of care, support faster and more confident clinical decisions, reduce variability, and expand access to advanced capabilities. Its initial applications address interventional guidance and trauma triage, beginning with neuraxial procedures and musculoskeletal injury assessment. RIVANNA has established an FDA-cleared product portfolio and maintains a worldwide intellectual-property portfolio of more than 100 issued and pending patents. RIVANNA is headquartered in Charlottesville, Virginia, and operates an FDA-registered, ISO 13485:2016-certified manufacturing facility.
Frequently Asked Questions:
What is ICD-10-PCS code XEZU3HC?
XEZU3HC is an ICD-10-PCS procedure code that identifies computer-aided guidance for intraprocedural navigation using ultrasound imaging with continuous needle tracking in the spinal canal, percutaneous approach. CMS created the code in the FY2027 ICD-10-PCS code set, placing it in Section X, New Technology, under a newly created table XEZ. It is the first dedicated ICD-10-PCS identifier for this form of guidance during neuraxial anesthesia.
When does ICD-10-PCS code XEZU3HC take effect?
XEZU3HC is effective for inpatient discharges occurring on or after October 1, 2026.
How were these procedures coded before XEZU3HC?
Use of diagnostic ultrasound navigation during neuraxial anesthesia was not separately reportable in inpatient hospital coding. Facilities could report the underlying neuraxial anesthesia under existing codes, but the navigation component remained indistinguishable in administrative data.
Does XEZU3HC establish additional payment?
No. XEZU3HC does not by itself establish separate payment. Its function is identification: creating a consistent way to distinguish navigated from non-navigated neuraxial procedures in inpatient hospital data.
Is XEZU3HC specific to a particular device or manufacturer?
No. The code applies to a procedural category, not to a specific company or product. Facilities may report it when the documented inpatient procedure meets the complete code definition.
Why does a procedure code matter for neuraxial anesthesia?
Without a dedicated identifier, navigated and non-navigated procedures cannot be distinguished consistently in ICD-10-PCS administrative data, limiting standardized tracking of adoption and linked outcomes at scale. The United States has no dedicated mandatory national reporting system for unintended dural puncture, and the consequences are not always brief: in a prospective multicenter cohort study that enrolled 90 patients with accidental dural puncture and 180 matched controls, 58% of those who experienced accidental dural puncture still had persistent headache at 18 months, compared with 17% of controls (Niraj 2021).
What is Accuro 3S, and how does it relate to XEZU3HC?
Accuro 3S is an AI-enabled ultrasound guidance system purpose-built for neuraxial anesthesia. SpineNav-AI provides automated identification of lumbar spinal landmarks, midline, and depth to the epidural space. SafeTrack displays the needle-tip location and trajectory relative to ultrasound image data in real time. Facilities may report XEZU3HC when the documented inpatient procedure meets the complete code definition.
Coding information is provided for general informational purposes. Code assignment is the responsibility of the reporting facility and should be based on the complete medical record and applicable official coding guidance.
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