Each year, the American Medical Association (AMA) updates CPT (Current Procedural Terminology) codes to reflect changes in technology, care delivery, and policy. These updates aren’t just administrative—they directly impact how services are coded and reimbursed.
Missing CPT updates can result in:
Claim denials
Compliance risks
Lost revenue
Who Should Pay Attention?
Everyone involved in medical coding, billing, and reimbursement, including:
Providers – need accurate codes to get paid properly.
Coders & Billing Teams – must apply the correct, current codes.
Payers (Medicare, Medicaid, Insurers) – align payment policies to new codes.
Health systems, RCM vendors, auditors – update systems, workflows, and compliance rules.
Key Changes in CPT 2026
1. New Code Additions
These include AI, telehealth, and remote monitoring.
Examples:
AI-based image review (e.g., algorithm helps read a chest X-ray)
Telehealth codes 98000–98016 – specify if visit is audio, video, or both
RPM/RTM – expanded to include wearables and sensors with new thresholds
Tip: Coders must document modality (audio/video), time spent, and technology used.
2. Code Deletions
Certain outdated codes, especially audio-only phone visit codes, are being retired.
Example:
Old code for 5-minute phone call → Removed
Now replaced by broader telehealth code (video or hybrid)
Tip: Avoid using deprecated telephone codes—they may no longer be reimbursed.
3. Code Revisions
Some existing codes are updated for clarity or compliance.
Changes include:
Tumor staging criteria
Vascular surgery bundling logic
Documentation tightening (e.g., medical necessity, risk level)
Example:
A code for vascular repair may now require specific documentation of lesion size and approach used.
Specialty-Specific CPT Updates
Telehealth & Virtual Care
Codes 98000–98016
Indicate type (audio/video), time, and complexity
More detailed than previous codes
Example:
98002: 15-min video follow-up visit for chronic condition
Remote Monitoring (RPM/RTM)
New codes reflect updated thresholds (e.g., minimum of 16 days of data)
Some codes now bundle device setup and analysis
Example:
RPM code for a wearable heart monitor that tracks data for 20 days
Artificial Intelligence (AI)
New AI codes allow billing for:
AI-assisted interpretation
Decision support tools
Documentation Required:
How AI influenced the decision
AI software version
Physician’s role in reviewing AI output
Example:
Radiologist uses AI to assist with MRI read → Code includes AI involvement
Audiology & Hearing Devices
Changes to hearing aid and cochlear implant coding
Possible new codes for remote tuning or tele-audiology
Radiology & Imaging
New modifiers may indicate AI-assisted vs manual reads
Updated rules for bundled imaging + procedures
Example:
CT scan with contrast plus AI read → Use new modifier for AI support
Surgical & Vascular Procedures
Updated complexity levels
New codes for robotic-assisted or AI-assisted surgery planning
Proprietary Laboratory Analyses (PLA)
New PLA codes for FDA-approved or CLIA-validated tests
Includes molecular and genomic tests
Tip: Not all payers adopt PLA codes at the same time—check payer bulletins.
FAQs for Coders
Q: What are the key new CPT codes for 2026?
A: Codes for AI-based interpretation, telehealth (98000–98016), and remote monitoring thresholds.
Q: Can we still bill for audio-only telehealth?
A: Many audio-only codes are being retired. Most payers now require video or hybrid documentation.
Q: What must be documented for AI codes?
A:
How AI supported the decision
Human oversight of the AI output
Algorithm or tool used
Q: When are PLA codes effective?
A: Depends on the payer. AMA publishes codes, but CMS and commercial plans may adopt at different times.
Preparing Your Practice for CPT 2026
1. Update Your Systems
Make sure EHR, billing software, and edits support new CPT codes (98000+, PLA, AI)
2. Train Staff
Conduct workshops or short sessions for coders and providers
Provide code summaries, examples, and documentation checklists
Example:
Create a cheat sheet showing:
| Code | Description | Documentation Needed |
|---|---|---|
| 98002 | 15-min video visit | Modality, duration, symptoms |
3. Track Payer Policies
Monitor CMS and private payer bulletins
Keep a tracker of which payers accept which new codes
4. Audit for Compliance
Review charts using new codes
Confirm documentation meets new standards
Watch for patterns in denials or payer edits
Conclusion
The CPT 2026 code changes reflect a major shift in how care is delivered and documented—especially for telehealth, AI, remote monitoring, and lab testing. Coders play a critical role in ensuring:
Accurate coding
Proper documentation
Timely reimbursement
