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Coding

2026 CPT Updates

The American Medical Association (AMA) has released the 2026 CPT code set with 288 new codes, 84 deletions, and 46 revisions.

The changes reflect evolving care delivery (digital/remote monitoring, AI/augmentative services), new technologies, and restructuring of existing procedure codes to better match modern workflows. From a practical standpoint, coders and billing teams should begin preparing now—code sets will take effect January 1, 2026, for many Category I changes.

Digital Health and Remote Care Take Center Stage

The expansion of Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) continues to grow. New codes allow reporting for shorter data collection periods—as few as 2-15 days—instead of the previous 16-day minimum.

A new code will also cover 10 minutes of clinical staff time spent managing a patient's remote data in a 30-day period, giving more flexibility for practices with lower-volume monitoring needs.

Coding Tip: Document exactly how many days of data were collected, which device was used, and how much time was spent reviewing or managing the results.

AI and Algorithm-Assisted Services Enter the Mainstream

Artificial intelligence is no longer just a tech buzzword; it's now part of the CPT code set.

New AI-assisted service codes recognize algorithms that support clinicians by analyzing medical data and producing insights such as:

Perivascular fat analysis to assess cardiac risk
Coronary plaque assessment via CT
Multispectral imaging for burn depth and wound healing
AI-based cardiac function analysis using ECG or acoustic data

Coding Tip: To report these services, the documentation must identify the algorithm or software used, describe how it assisted the clinician, and include the physician's interpretation and final decision.

Codes added for AI/algorithmic services that assist clinicians (e.g., non-invasive burn wound healing classification, perivascular fat analysis for cardiac risk, coronary plaque assessment via AI) are to reflect augmentative and assistive AI services.

This signals that coders and practices must begin familiarizing themselves with how to document the use of AI/augmented tools and assign the new codes appropriately.

Expansion and Restructuring of Procedural Codes

There is significant restructuring in certain specialty areas—especially in interventional radiology/vascular, lower-extremity revascularization, prostate biopsy, endovascular therapy, and thoracic branch endografts. For example, the set of codes 37220-37235 (lower extremity revascularization) will be deleted and replaced with approximately 46 new codes organized by vascular territory.

In imaging/radiology, there are new head and neck CTA codes, CTP codes replacing older Category III, and irreversible electroporation (IRE) of liver and prostate getting new Category I.

Proprietary Laboratory Analyses (PLA) and Emerging Technologies

A large portion of new codes (approximately 27%) are for proprietary laboratory analyses.

Also, new Category III codes (for emerging services/technologies) have been introduced/expanded.

Major Overhaul: Vascular and Interventional Radiology

One of the largest restructurings in years occurs within lower extremity revascularization. The long-standing code family 37220–37235 will be deleted and replaced by roughly 46 new codes organized by specific vascular territories—iliac, femoropopliteal, tibial-peroneal, and inframalleolar.

This change aims to clarify reporting by vessel and intervention type, but it will require extensive retraining for coding and clinical teams.

Documentation should clearly describe:

Which vessels were treated
The approach used (open vs. endovascular)
The specific techniques performed (angioplasty, stent, atherectomy)
Imaging guidance details
Codes 37220-37235 (older “group”) will be deleted for 2026. They will be replaced by 46 new codes (37X xx series) that specify vascular territory (iliac, femoral/popliteal, tibial/peroneal, inframalleolar).

Practices doing revascularization must update all their systems (EHR, billing, pre-auth, templates) and train physicians/documentation so that the new structure is captured correctly (territory, approach, device, imaging guidance) to avoid revenue cycle disruption.

Imaging, Radiology, and Endovascular Updates

Radiology sees numerous updates across CTA, CTP, and ablation procedures.

New Category I codes replace older Category III entries for head and neck CTA and CT perfusion imaging.

New codes are also introduced for irreversible electroporation (IRE) of the liver and prostate, while thoracic branch endograft procedures receive their own structured reporting options.

Expect bundling and guideline changes affecting imaging guidance (fluoro, CT, ultrasound) and embolization/occlusion procedures.

Always verify which imaging modality was used and whether it's separately reportable under 2026 rules:

New Category I codes for head and neck CTA, CTP, IRE of liver/prostate, thoracic branch endograft services, prostate biopsy codes revised, and sacroiliac arthrodesis updates.
Revised guidelines for vascular embolization/occlusion, endovascular therapy, and bundling of some imaging guidance codes (61624/61626), etc.

Documentation must clearly reflect new descriptors, capture imaging guidance, approach, vascular territory, and device types. Coders must delete old codes and map to new ones effective January 1, 2026.

Modern Hearing Device Services

The 2026 code set modernizes hearing-related services, replacing outdated terminology with codes that better match real-world practice.

New options include:

Assessing visual, dexterity, and psychosocial factors
Validating device performance
Training patients on smartphone-connected devices

Capture the type of device used, testing performed, and counseling provided during the visit:

New codes for hearing device services (12 codes) reflecting modern approaches (assessing visual/dexterity/psychosocial factors, validating device performance, and training support for smartphone-connected devices).
New AI-assisted service codes (e.g., perivascular fat analysis for cardiac risk, coronary plaque assessment via CT, multispectral imaging for burn wounds, detection of cardiac dysfunction via algorithmic acoustic/ECG analysis).

Documentation must include the fact that the service is algorithm/AI-assisted, the clinical input by the physician, the device/software used, and the output (e.g., risk score or image classification) so coders can determine eligibility for the new codes vs. standard services.

Radiation Oncology and Category III Migrations

Outdated radiation treatment codes are being retired, and the simple/intermediate/complex terminology will disappear. Meanwhile, several Category III procedures—once considered experimental—are graduating to Category I status after widespread adoption and supporting data.

Coding Tip: Review every Category III service you report to see if it's being replaced by a new Category I code in 2026.

Deleted and Revised Codes: Clean Up Before January 1

Hundreds of existing codes will be deleted or revised for clarity, bundling, or obsolescence. Old codes often linger in EHR templates, charge masters, or provider favorites—creating a major compliance risk if not removed before the new year.

Action steps:

Build crosswalks between deleted and replacement codes.
Lock down outdated codes in your billing software.
Educate your entire team before January 1, 2026.

Keep in mind:

Several codes will be deleted due to bundling or redundancy. Example: 0042T (CT cerebral perfusion) will be deleted/replaced.
Radiation oncology treatment delivery codes (77014, 77385, 77386) will be deleted; the terminology “simple/intermediate/complex” will be retired.
The Category III code list sees an addition of 38 new codes (0988T-1025T), among others.

Coders must validate that their codebooks/billing systems are updated. Using deleted codes after their effective dates can lead to denials or incorrect payments.

Documentation and Billing Impact

With the proliferation of new codes, practices must revise documentation templates to include the new required elements (e.g., vascular territory for LE revascularization, days of data for RPM, algorithm/AI support for services, guidance imaging used, device supply).

Billing systems must be updated for code mapping, crosswalks from old to new codes, and payors notified if using proprietary or AI services.

Pre-authorizations/medical necessity justification may become more complex, especially for new territory-specific codes or AI/augmented services. Physicians need to capture the rationale for why the service (e.g., IRE of prostate, AI perivascular fat analysis) was medically necessary.

Coding education will be critical. Coders and billers must be trained on new descriptors and effective dates (some Category III codes have an implementation date of July 1, 2025).

If older codes are deleted and not replaced with the new, correct ones, claims may be denied or downcoded. For example, the LE revascularization structure overhaul is a major risk area.

Implementation Timeline and Effective Dates

Dates to remember:

Category I codes for 2026 take effect January 1, 2026.
Some Category III codes (emerging technology) may have July 1, 2025, effective dates (six-month implementation) for the 2026 cycle.
Practices should target finishing internal updates (EHR, billing, education) by year-end 2025 to avoid disruption on January 1.

Also note, the proposed changes to the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule for CY 2026 are relevant to CPT changes (conversion factors, reimbursement changes)—so coders/billers should stay aware of that overlap.

Why This Matters for You

As a coder/auditor/practice manager, you must focus on:

Compliance and Accuracy: Using outdated codes means risk of non-compliance, denial, or audit.
Revenue Optimization: The new codes better align with modern services (shorter durations, digital/remote care, AI services). Capturing them correctly can ensure appropriate reimbursement.
Documentation Burden: May increase slightly because new codes often require additional qualifiers (territory, days, software use, device supply). Advance training reduces surprise.
System Changes: EHR and billing systems will need to incorporate the new code descriptors and guidelines. Crosswalks from old to new codes should be prepared.
Payor Awareness: Educate payors (especially commercial/private insurers) about the new codes, particularly in less familiar areas (AI/remote monitoring) to anticipate coverage and reimbursement issues.
Education and Training: Coders should study the “CPT Changes 2026” materials, attend webinars, and update in-house cheat sheets/quick references.

Action Plan Checklist

Here's a suggested checklist for your team to prepare:

Obtain the official CPT 2026 codebook (Professional Edition) and “CPT Changes 2026: An Insider's View.”
Review the major areas of change relevant to your specialty (e.g., imaging, cardiology, remote monitoring) and create a “top changes” list for your practice.
Update documentation templates (EHR) to capture required qualifiers for new codes (e.g., days of data for RPM, vascular territory for revascularization, software/algorithm name for AI-services).
Update billing system crosswalks; mark deleted codes, map to new codes, create alerts for use of correct codes after Jan 1, 2026.
Educate coders, billers, and providers; hold training sessions covering the new code sets, effective dates, and common pitfalls.
Audit/monitor first-quarter 2026 claims closely; review whether new codes were used appropriately, check payor responses, and identify denial patterns.
Communicate with payors, especially for newer services (AI-assisted, hearing device services, remote monitoring) to prepare to support medical necessity and device/software descriptions.
Monitor RVU and reimbursement impacts; given the conversion factor/proposed fee schedule changes for CY 2026 (e.g., separate conversion factors for qualifying APMs), your revenue cycle team should understand how these code changes intersect with payment policy.

Key Challenges and Considerations

New changes bring new challenges, including:

Transition Risk: With major code deletions (e.g., LE revascularization set) and new codes, the potential for miscoding is high. Mistakes may lead to revenue loss or compliance issues.
Payor Variability: Some payors may lag in recognizing new codes, particularly emerging technology/AI codes. Be prepared with backup documentation and possibly step-through appeals.
Workload and Documentation Burden: While the aim is better specificity, the additional qualifiers may add documentation time. Staff workload should be factored into planning.
System Readiness: EHR and billing platforms must be updated in a timely manner. Delays can lead to claims being rejected with outdated code sets.
Education Depth: Particularly for specialties heavily impacted (radiology/interventional), the code restructuring is the most extensive in many years. Coders will need deeper training than usual.
Monitoring/Payor Audits: New codes may attract attention from payors/check-audit units; proper documentation will help defend claims.

Putting It All Together

The CPT 2026 update is more than an incremental change; it reflects meaningful shifts in how services are delivered (digital, remote, AI), how procedural specialties are coded (territory-specific vascular codes), and how documentation/billing must evolve. For medical coding professionals, being ahead of this change is a competitive and compliance necessity.

By following the action plan, aligning documentation and billing systems, and educating your team proactively, you can minimise risk, optimise reimbursement, and support providers in delivering the documented reality of modern healthcare.

Coding Clarified's Takeaway

The CPT 2026 code set reflects where healthcare is heading—data-driven, digital, and precision-based. Preparing early means smoother billing, fewer denials, and continued compliance in a rapidly evolving field.

Coders who understand the why behind each change won't just keep up—they'll lead.

Janine Mothershed is the founder and CEO of Coding Clarified, an innovative online medical coding school committed to transforming lives through flexible, high-quality career training. A Certified Professional Coder (CPC) and licensed AAPC instructor, Janine brings over a decade of experience in healthcare administration, medical coding, and workforce development.

https://codingclarified.com

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Understanding the Changes in the CMS-HCC Model V28:The New Year brought with it a long-overdue overhaul of the Centers for Medicare and Medicaid Services (CMS) hierarchical condition categories (HCC), ushering in the 28th version of the model used to assign risk adjustment factor (RAF) scores and estimate future healthcare costs for Medicare Advantage patients.

Coding

Coding for Zika: Unraveling the Threat of a Silent Predator:When we consider treacherous animals, our thoughts may drift to lions, bears, and sharks. Yet, the true menace is a far less conspicuous creature: the mosquito. This seemingly harmless insect can spread many deadly diseases, including Zika, dengue fever, yellow fever, and West Nile virus. In this article, our focus is on the Zika virus, exploring its means of transmission, presenting symptoms, diagnostic methods, and available treatments. Furthermore, we shed light on medical coding for Zika, providing nine detailed examples to simplify the accurate assignment of ICD-10-CM codes in accordance with established guidelines and conventions.

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How Are Radiology Practices Impacted by Annual Changes to the Medicare Physician Fee Schedule?:With passage of the Consolidated Appropriations Act, 2024 (CAA 24), we finally learned the rates that physicians will be paid for Medicare services during the remainder of 2024. Effective when it was signed by the president on March 9, 2024, the CAA 24 contained several provisions that benefitted physician reimbursement:

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Coding Changes That Will Impact Radiology Practices in 2024:The annual update to the Current Procedural Terminology (CPT)® for 2024 has 230 new codes, 70 revised codes, and 49 deleted codes. In addition, there are 395 new diagnosis codes contained in the ICD-10-CM update, about one-third of them describing new ways to capture accidents and injuries. Although relatively few of these changes will impact radiology practices, it's essential to know what they are and adjust your practice systems accordingly.

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Breaking Down Misconceptions: Understanding Thyroid Diseases:Imagine a tiny butterfly-shaped gland quietly regulating your body's energy levels and overall health. Your thyroid, which uses iodine to make thyroid hormones, helps control blood pressure, body temperature, heart rate, metabolism, and the reaction of your body to other hormones. Thyroid disorders occur when the gland becomes overactive (hyperthyroidism) or underactive (hypothyroidism). When the thyroid is not working as it should, it can result in serious health problems.

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ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD):Chronic Obstructive Pulmonary Disease (COPD) is a progressive and persistent inflammatory lung disease resulting in limited airflow. Primary causes of COPD are long-term exposure to irritating gases or particulate matter, most commonly from cigarette smoke. There are multiple factors that can contribute to the development of COPD, such as:

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Demystifying EKG and Telemetry for the Non-Clinician:Electrocardiograms (EKG or ECG) and telemetry are indispensable tools in the field of cardiac health. They have revolutionized how healthcare professionals diagnose and monitor various heart conditions, from arrhythmias to heart attacks. EKGs record the heart's electrical activity, while telemetry involves wireless data transmission from a patient's heart to a healthcare provider.

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Valentine's Day - From Romance to Responsibility: STD Awareness:>Love is in the air, and hearts are excited as we celebrate Valentine's Day. Yet, amidst the whispered promises and tender embraces, we need to remember that pure love is about caring for each other's well-being. Regular testing is essential for anyone who is sexually active to avoid STIs 365 days a year. Getting tested is necessary to give love and maintain your sexual well-being. More than flowers, chocolates, or champagne, knowing the facts about STDs and taking the necessary precautions are the best ways to celebrate love responsibly, passionately, and to its fullest.

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Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing:Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing: In the complex world of healthcare, accurate reporting of services is crucial for ensuring quality patient care and fair compensation for medical providers. One significant aspect of this process involves purchased diagnostic testing, where medical tests are conducted outside the healthcare organization. In this tip, we'll delve into the essentials of healthcare claim reporting and the auditing process related to purchased diagnostic testing.

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Fathom Announces Partnership with Google Cloud, Adding its Autonomous Medical Coding Solution to Google Cloud Marketplace :This collaboration will boost access and integration with best-in-class autonomous medical coding for healthcare providers.

Coding

Modifier -25: Interpretation Is In The Eye of the Beholder :Fresh insights from the American Medical Association (AMA) are always welcome when it comes to medical coding policy. Although they have provided previous guidance on the appropriate use of modifier -25, the AMA's

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Should I Report the Symptom or Confirmed Diagnoses for Testing?:Coders frequently ask questions about the guidelines surrounding coding symptoms vs. confirmed diagnoses, especially when tests are ordered during an encounter to rule out a condition, illness, or disease.

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Optimizing HCC Coding for Accurate Reimbursement:Hierarchical Condition Category (HCC) codes are an integral aspect of healthcare’s ongoing transition from fee-for-service to a value-based care model of reimbursement—a transition that requires providers to better manage patient costs based on a clear, concise, and comprehensive picture of patients’ health and medical conditions.

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Understanding CPT Code Range 92920-93793 in Cardiology Billing :The realm of cardiology encompasses a vast array of specialized services and procedures, demanding precise documentation and accurate coding for proper reimbursement. Understanding the specific CPT codes within the range of 92920-93793 is crucial for healthcare providers navigating this complex landscape. This article serves as a detailed guide, unpacking the details of this CPT code range 92920-93793 and its applications within cardiology billing.

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Missing HCC Codes Leave Money on the Table:Improper clinical documentation of one patient can mean a difference of more than $10,000 in yearly estimated healthcare costs. How much money are you potentially leaving on the table?

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Big Changes Will Streamline CPT Coding for Immunization :Significant changes in the Current Procedural Terminology (CPT ® ) code set for immunizations reflect the changing nature of how COVID-19 is being addressed as actions transition from a public health emergency response to combatting emerging variants much like the flu.

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Time Changes for 2024:Beginning January 1, 2024, providers utilizing time for leveling an office and/or outpatient Evaluation and Management (E/M) service must meet or exceed the minimum threshold total service time. This change for 2024 better aligns with time changes that were already made in 2023 for inpatient settings.

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The Impact and Challenges of Sequencing Z Codes for Reimbursement :Every year, we get updates to the Official Guidelines for Coding and Reporting, and this year, for reporting year 2024, we received an update regarding Chapter 21 for follow-up codes Z08 and Z09. The accurate sequencing of these Z codes was emphasized in the guideline update by reminding us that they can be used for both medical and surgical treatment.

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Updated ICD-10-CM Codes for Appendicitis :According to JAMA, there are approximately 250,000 cases of appendicitis diagnosed annually in the United States. Appendicitis can quickly spiral out of control when a perforation of the appendix occurs, and a patient becomes septic. Understanding the language used in medical documentation helps with the proper assignment of ICD-10-CM codes and supports testing and treatment.

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Update on Policy for Using Modifiers JW and JZ:JW has been a requirement since 2017; however, Medicare is using the JW modifier and JZ modifier to calculate discarded drug refunds, effective January 1, 2023.

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Capturing HCCs in a Changing World:On March 31, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Advantage (MA) Capitation Rates along with Part C and Part D payment policies. The largest key decision in the release was the finalized proposal to revise the Medicare Advantage Risk Adjustment model.

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Aetna Reimbursement Policy: Radiology Modifiers:According to provider October updates: Aetna will reduce the reimbursement rate for HCPCS radiology codes when modifiers FX and FY are appended.

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Reviewing the Guidelines for Reporting ICD-10-CM Aftercare Codes:Aftercare codes are assigned to explain encounters where the initial treatment of a disease has been completed and the patient encounter is now focused on aftercare for healing and recovery. These codes may also be reported to explain long-term consequences of the disease.

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COVID Vaccine Coding Changes as of November 1, 2023:Correctly coding the administration of COVID-19 vaccines had become such a huge burden for providers.

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2024 ICD-10-CM Code Changes:It's that time of the year again. The new ICD-10-CM code books are out, and the changes are now active. There are 395 new diagnosis codes, 25 deleted codes, and 12 revised codes for 2024. As a healthcare professional, the ability to understand and navigate the updated ICD-10-CM codes is integral. Mistakes or misunderstandings can lead to claim denials, inaccurate data collection, and potential patient harm. It is vital to engage in continued education to understand these changes fully. This article will provide an overview of the new codes for ICD-10-CM for 2024.

Coding

Truly Autonomous Coding Requires a Multifaceted Solution:Coding technology has come a long way since the days when Computer-Assisted Coding (CAC) was a bleeding edge feature of the more advanced encoder solutions. Today's CAC solutions are often integrated with Clinical Documentation Integrity (CDI) tools and have automated much of the coding process.

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Why Support for H.R. 2474 Is Important to Your Radiology Practice:The Strengthening Medicare for Patients and Providers Act (H.R. 2474) would modify the way the Medicare Physician Fee Schedule (MPFS) is calculated and adjusted each year. The basic system of determining Relative Value Units (RVU) would not change, but the annual adjustment of the Conversion Factor (CF) would more closely reflect the actual economic factors that affect physicians' practices.

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Pediatric Craniosynostosis Coding in ICD-10-CM:Craniosynostosis, a complex craniofacial condition, impacts approximately one in every 2,500 babies in the United States. This article delves into the complexity of this congenital disability, shedding light on its various forms, categorized broadly by either an unknown cause or an underlying condition. Moreover, we explore ICD-10-CM coding for these diagnoses, including the recent updates as of October 1 of this year, designed to reflect the diverse types of craniosynostosis.

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Radiology Practices Struggle to Avoid Penalties in the Medicare Quality Payment Program:For many radiology practices, the idea of a positive payment adjustment for participation in the Medicare Quality Payment Program (QPP) has been lost. Several factors have combined over the past few years to change the goal for radiology practices - it is now "penalty avoidance" rather than a reward for reporting quality metrics. As outlined in Healthcare Administrative Partners' recent review of the Medicare 2024 Physician Fee Schedule Proposed Rule, the QPP requirements for successful participation are going to become even stricter.

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The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance:The ICD-10-CM annual updates scheduled for implementation on October 1, 2023, include 395 new codes, 25 deleted codes, and a total of 13 revised codes. Among the newly added codes are codes that better define metabolic disorders, such as metabolic syndrome, also known as insulin resistance syndrome, dysmetabolic syndrome, hypertriglyceridemic waist, obesity syndrome, and Syndrome X.

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Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding:GERD stands for Gastroesophageal Reflux Disease, a chronic condition where stomach acid flows back into the esophagus, causing a range of symptoms, such as heartburn, regurgitation, chest pain, difficulty swallowing, and a chronic cough.

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ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2023 Update:CR 13166 is a maintenance update of ICD-10 conversions and other coding updates specific to NCDs.

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E/M Scoring Questions:Evaluation and Management visits are often the "bread and butter" of an organization. Thus, correctly scoring encounters is essential to ensuring proper reimbursement. The element of "Risk" is only one of the three elements of Medical Decision Making (MDM) but understanding what is meant by all the definitions within each element is critical.