The American Medical Association (AMA) released the CPT 2026 code set on September 11, 2025, with changes effective January 1, 2026. This is one of the largest updates in years, driven by:
- Rapid growth in digital health and remote monitoring
- The rise of AI‑augmented services
- A major overhaul of lower extremity revascularization (LER)
- Modernization of hearing device services
- Ongoing innovation in cardiovascular, radiology, pathology, and vaccines
If you touch coding, billing, documentation, or revenue cycle in any way—this update matters.
1. Why These Changes Matter: Stats & Big Picture
Headline numbers:
- 418 total changes
- 288 new codes
- 84 deletions
- 46 revisions
- Roughly:
- 27% of new codes are Proprietary Laboratory Analyses (PLAs)
- >25–27% are Category III codes for emerging technologies
Strategic implications:
- Revenue opportunities
- Expanded remote patient monitoring (RPM) for short‑term/acute use
- Newly recognized AI‑augmented diagnostics
- More granular vascular and audiology coding
- Risk of denials
- Legacy codes (e.g., 37220–37235 for LER; some PLAs like 0450U/0451U) will no longer be valid
- Time thresholds and documentation requirements are changing (e.g., RPM management from 20 to 10 minutes)
- Operational urgency
- Systems, fee schedules, and templates must be ready before January 1, 2026
- Especially critical for high‑volume RPM, cardiology/vascular, radiology, and audiology practices
2. At‑a‑Glance: 2026 CPT Change Summary
| Category | New Codes | Deletions | Revisions | Key Focus Areas |
|---|---|---|---|---|
| Total CPT 2026 Changes | 288 | 84 | 46 | Digital health, AI, vascular, audiology, vaccines, radiology |
| Remote Monitoring (RPM/RTM) | ~7 | – | Several | Shorter monitoring periods, reduced time thresholds (e.g., 10 min management) |
| AI‑Augmented Services | Several | – | – | Cardiac risk analysis, burn wound imaging, AI‑driven cardiac dysfunction tools |
| Hearing Device Services | 12 | Legacy 92590–95 | Some | Time‑based, patient‑centered hearing device assessment and training |
| Lower Extremity Revascularization | 46 | 37220–37235 | – | Territory‑based, simple vs. complex, outpatient focus |
| Proprietary Laboratory Analyses (PLA) | ~78 | Several | – | New diagnostics; some older PLAs deleted (e.g., 0450U, 0451U) |
| Category III (Emerging Tech) | ~78 | – | – | Advanced procedures (e.g., HIFU, novel interventions) |
3. Deep Dive on Major 2026 CPT Changes
3.1 Digital Health & Remote Patient Monitoring (RPM/RTM)
Theme: Moving from long‑term, chronic‑only RPM to shorter, flexible episodes that support acute and post‑discharge care.
Key coding changes (examples from your content):
- New codes
- 99445 – Device supply + collection/summary of patient data for 2–15 days within a 30‑day period
- 99470 – First 10 minutes of RPM treatment management in a calendar month
- Additional new RPM/RTM codes for remote monitoring over 2–15 days (total ~5 codes in this new short‑burst group)
- Revised codes
- 99454, 99457, 99458 – Adjusted descriptors and reduced time thresholds (e.g., moving from 20 to 10 minutes)
Operational & revenue impact:
- More billable use cases
- Short‑term RPM for post‑op, post‑discharge, acute exacerbations, and intermittent monitoring
- Lower time thresholds = more accessible
- Practices can meet criteria more consistently, potentially increasing RPM revenue
- Telehealth alignment
- Codes are compatible with telehealth (see CPT Appendices P/T where applicable)
- Action item:
- Audit your current 2025 RPM codes and identify:
- Which patient cohorts could move to short‑burst RPM in 2026
- Where decreased minute thresholds will increase billable activity
- Audit your current 2025 RPM codes and identify:
3.2 AI‑Augmented & Assistive Services
Theme: 2026 cements reimbursement for AI‑augmented workflows, with CPT explicitly recognizing services where AI assists—but does not replace—clinician judgment.
Examples of new AI‑related services:
| Service Area | Example Description (High Level) |
|---|---|
| Coronary Plaque Assessment | AI analysis of CT angiography to quantify atherosclerotic plaque and severity |
| Perivascular Fat Analysis | AI assessment of perivascular fat around coronary arteries for cardiac risk, with codes for with/without concurrent heart CT |
| Burn Wound Imaging | Multispectral imaging with algorithmic classification of wound healing status |
| Cardiac Dysfunction Detection | AI interpretation of acoustic or ECG signals to identify reduced EF, murmurs, AFib, etc. |
Documentation & compliance tips:
- Clearly document:
- Clinical indication
- Data source (CT, ECG, acoustic, imaging)
- AI tool used (by brand/type if relevant)
- Physician/qualified professional oversight and interpretation
- Emphasize that AI augments (not replaces) clinician work—key for coverage and audits.
Revenue angle:
- New codes convert previously “incidental” AI output into billable services when medically necessary and appropriately documented.
3.3 Lower Extremity Revascularization (LER): Full Overhaul
This is the single most dramatic procedural change in CPT 2026.
What’s changing:
- Deleted:
- Legacy LER codes 37220–37235
- New:
- 46 new codes, roughly 37254–37299, organized by:
- Vascular territory:
- Iliac
- Femoral/popliteal
- Tibial/peroneal
- Inframalleolar (foot)
- Complexity: “Simple” vs. “complex” interventions
- Add‑on codes for additional vessels/territories
- Vascular territory:
- 46 new codes, roughly 37254–37299, organized by:
Why the change:
- Reflects:
- Advances in endovascular techniques (stents, imaging, atherectomy)
- Shift of many procedures to outpatient and office‑based labs
- Targets more precise reporting for peripheral artery disease (PAD) symptoms such as claudication, pain, and cramping.
Risks & action items:
- High denial risk if you keep using deleted codes in 2026
- Immediate needs for vascular, cardiology, and IR groups:
- Build a 2025→2026 crosswalk from 37220–37235 to the new 37254–37299 family
- Update order sets, op notes, charge capture, and preference cards
- Train physicians on new territory‑based coding logic and simple vs. complex definitions
3.4 Hearing Device Services (Audiology)
Audiology undergoes a modern, patient‑centered redesign.
Key structural changes:
- New codes:
- 12 time‑based hearing device codes: 92628–92642 (per your content)
- Deleted/legacy:
- Older hearing aid codes such as 92590–92595
Clinical focus of the new family:
- Candidacy & functional assessments
- Include evaluation of vision, dexterity, cognition, psychosocial factors, lifestyle, and listening environments
- Device performance & verification
- Measurement of real‑ear response, sound quality, and fitting verification
- Patient‑owned & smart/connected devices
- Training on:
- Smartphone pairing and apps
- Remote adjustments
- Use of over‑the‑counter and prescription devices
- Training on:
Takeaways for audiology practices:
- You gain more flexible, granular coding that reflects time and complexity, rather than a single “hearing aid fitting” concept.
- Make sure:
- Templates capture time, activities performed, and device type
- Billing understands when to use new codes vs. verification or training codes as separate services
3.5 Other Notable 2026 CPT Changes
Cardiovascular (Non‑LER)
- Thoracic aorta repairs:
- Revisions to codes 33880–33886 for endovascular thoracic aortic repair (TEVAR), improving clarity and alignment with current techniques.
- Coronary interventions:
- Updates to the 92920–92945 family, with 8 revisions and 6 deletions, refining how percutaneous coronary interventions are reported and bundled.
Radiology & Radiation Oncology
- CT and perfusion:
- New CT angiography/perfusion studies, such as 70471–70473, expanding options for advanced neuroimaging and cerebrovascular assessment.
- Surface radiation therapy:
- New codes 77436–77439 for skin/surface radiation treatments, reflecting new delivery methods and technologies.
Vaccines & Immunizations
- New RSV vaccine code:
- Addition of 90382 for RSV.
- Influenza updates:
- New and revised codes for evolving influenza products and combinations.
Prostate Biopsy
- New targeted prostate biopsy codes:
- 55707–55715, addressing advanced targeting methods (e.g., MRI‑fusion guidance, extended sampling strategies).
Behavioral Health & Telehealth
- Expanded and clarified telehealth appendices for:
- Audio‑only delivery
- Audio‑video delivery
- Greater alignment between behavioral health services and remote care modalities.
PLA & Category III Codes
- Approximately 78 new PLA codes and ~78 Category III codes:
- Support a wave of precision diagnostics, specialty lab tests, and emerging technologies (e.g., high‑intensity focused ultrasound, new minimally invasive procedures).
- Several outdated PLAs (including 0450U, 0451U) are deleted as tests and standards evolve.
4. Specialty Impacts & Revenue Opportunities
High‑Level Specialty Snapshot
| Specialty / Service Line | Key Wins & Opportunities | Main Risks & Watch‑Outs |
|---|---|---|
| Cardiology & Vascular | AI plaque/fat analysis; revamped LER; refined coronary codes | Mis‑mapping old 37220–37235 codes; incorrect territory/complexity coding |
| Interventional Radiology | New LER framework; updated CTA/perfusion; surface radiation codes | Bundling issues; failing to update charge capture and op note templates |
| Radiology | AI‑based imaging interpretations; advanced CT/perfusion | Documentation gaps for AI oversight; payer variability |
| Primary Care / Clinics | Short‑burst RPM and lower time thresholds; expanded telehealth support | Under‑utilizing RPM due to lack of workflows; inadequate staff training |
| Audiology | 12 new time‑based codes for hearing devices, verification & training | Confusion over legacy vs new codes; missing time/detail documentation |
| Behavioral Health | More explicit telehealth allowances (audio‑only and audio‑video) | Payer lag in policy updates; incorrect telehealth modifiers/appendices |
| Labs / Pathology | Dozens of new PLA and Category III codes | Using deleted PLAs; missing test‑specific coverage and prior auth changes |
5. Operational Playbook: How to Prepare for January 1, 2026
Use this as a practical checklist to “future‑proof” your 2026 billing.
- Audit & Crosswalk Codes
- Map:
- Old LER codes (37220–37235) → new 37254–37299 family
- Legacy hearing aid codes 92590–92595 → new 92628–92642
- RPM/RTM descriptors and time thresholds → 2026 rules
- Use the AMA’s official data file or vendor‑provided crosswalks.
- Map:
- Update EHR, PM, and RCM Systems
- Load all new/deleted/revised codes and ensure:
- Favorite lists, order sets, and templates are updated
- Alerts fire when staff attempt to use deleted 2025 codes in 2026
- If you use platforms like zHealth or similar, confirm auto‑update schedules.
- Load all new/deleted/revised codes and ensure:
- Revise Clinical Documentation Templates
- For RPM/RTM:
- Add discrete fields for minutes, days of monitoring, and clinical decision‑making.
- For AI services:
- Include prompts for tool name, data source, and physician oversight.
- For LER:
- Ensure op notes capture all treated territories, devices, and complexity.
- For RPM/RTM:
- Train Staff Across Roles
- Coders and billers:
- Deep dives on LER, RPM, AI codes, and hearing device families.
- Clinicians:
- Short, focused sessions on how their documentation drives 2026 codes.
- Consider:
- AMA’s CPT & RBRVS 2026 Annual Symposium
- AAPC and specialty society webinars
- Coders and billers:
- Engage Payers Early
- Ask major payers and Medicare contractors:
- Will new RPM and AI codes be covered and at what rates?
- Are there prior auth changes for LER, PLA, or new radiology services?
- Update payer policy libraries and educate staff accordingly.
- Ask major payers and Medicare contractors:
- Test & Monitor
- Run test/sandbox claims (where possible) for:
- New RPM codes (e.g., 99445, 99470 and short‑burst monitoring codes)
- AI‑augmented imaging services
- New LER and hearing device codes
- After go‑live:
- Track denials by code in 2026 Q1 and refine workflows quickly.
- Run test/sandbox claims (where possible) for:
6. Key Resources
- AMA CPT 2026 Resources
- AMA press release and official code set
- CPT® 2026 Professional Edition and data files
- AMA CPT & RBRVS 2026 Annual Symposium
- Coding & Education
- AAPC articles and webinars on CPT 2026
- Specialty society guidance (e.g., ACC, radiology & vascular societies)
- Vendor Tools
- EHR/PM vendor release notes and crosswalks
- Specialty RCM platforms and cheat sheets (e.g., zHealth, others)
(Use official AMA publications and certified coding resources for exact descriptors and guidelines.)
7. FAQs
Q: When do the CPT 2026 changes apply?
A: They apply to services performed on or after January 1, 2026. For dates of service in 2025, you must continue using 2025 CPT codes—even if claims are submitted in 2026.
Q: What’s the biggest revenue opportunity?
A: For most ambulatory practices, it’s the expanded RPM/RTM framework:
Short‑duration monitoring (2–15 days in a 30‑day period)
Lower minimum management time (e.g., 10 minutes instead of 20)
Better alignment with post‑discharge and episodic monitoring
Q: What’s the biggest risk area?
A: For procedural specialties, LER code mapping errors:
Using deleted 37220–37235 codes in 2026
Incorrect mapping to new territory‑based codes
This can result in widespread denials and lost revenue if not addressed proactively.
Q: How do AI‑related codes change documentation?
A: You’ll need to:
Name the AI tool/algorithm and data source
Document the clinical question being answered
Clearly show physician review, interpretation, and decision‑making
Q: Where can I get the official CPT 2026 book or data file?
A: Purchase directly from the AMA Store or major distributors (e.g., Amazon), and confirm you’re getting the 2026 edition.