The American Medical Association (AMA) has released its latest version of CPT codes for 2026. The new code set introduces new, revised, and deleted codes that will impact how services are documented and billed. Along with that, the Centers for Medicare & Medicaid Services (CMS) has brought changes to the Physician Fee Schedule (FPS), too.
This would affect claim submission processes and compliance requirements. The changes contained within the latest edition of CPT will become effective from January 2026. This guide will mention the key changes and explain CMS’s proposed rules. You’ll also get to know how expert medical billing services can help practices prepare for a smooth transition.
What are CPT Codes and CMS Updates?
CPT codes are standardized codes used by healthcare providers to describe medical, surgical, and diagnostic services. These are developed by the American Medical Association (AMA). They ensure that healthcare billing professionals, payers, and patients have a common language for reporting services.
On the other hand, the Centers for Medicare & Medicaid Services (CMS) issues regular updates to the Physician Fee Schedule (PFS) and related reimbursement policies. These updates determine how providers are paid for the services they deliver.
Together, CPT code changes and CMS updates directly influence:
- How services are documented and billed.
- The reimbursement rates providers receive.
- Compliance with payer and federal regulations.
What are the Major Changes in the 2026 CPT Code Set?
The 2026 CPT code set introduces important updates that highlight the changes in healthcare billing services and technology. The table below shows the quick breakdown of the total number of additions, revisions, and deletions in this year’s update.
| Category | Number of Changes |
|---|---|
| Total Changes | 418 |
| Additions | 288 |
| Revisions | 46 |
| Deletions | 84 |
Now that we have an overview of the numbers, let’s learn about the major updates and see how they impact medical billing in 2026.
Remote Monitoring
Five new codes were created to report remote monitoring services over short periods, 2–15 days within a 30-day period. Additionally, two new codes report remote monitoring treatment management after 10 minutes of service per calendar month, down from the previous 20-minute threshold.
Augmentative AI Services
There are several new codes that are added for AI services. Some examples include:
- Coronary Atherosclerotic Plaque Assessment evaluates the severity of coronary artery disease using advanced software analysis of data obtained from coronary computed tomographic angiography (CCTA).
- Multi-Spectral Imaging for Burn Wounds provides algorithm-based classification of burn healing status through noninvasive multispectral imaging.
- Perivascular Fat Analysis for Cardiac Risk involves two codes for noninvasive evaluation of cardiac risk, using advanced software analysis of perivascular fat, performed with or without a concurrent cardiac CT scan.
- Detection of Cardiac Dysfunction uses algorithmic analysis of acoustic and electrocardiogram (ECG) recordings to assist in identifying cardiac dysfunction.
Hearing Device Services (Effective Jan 1, 2026)
12 new CPT codes for hearing aid/device candidacy, selection, fitting, verification, assistive technology, and follow-up care.
| Category | Old Codes (Deleted) | New Codes | Description |
|---|---|---|---|
| Candidacy Evaluation | 92590–92595 | 92628 (first 30 min) + 92629 (each additional 15 min) | Evaluation for hearing aid candidacy, including assessment of hearing test results, communication needs, medical history, dexterity, and psychosocial factors. |
| Device Selection | — | 92631 (first 30 min) + 92632 (each additional 15 min) | Selection of hearing aids/devices based on candidacy results, communication goals, and individual needs. |
| Fitting Services | — | 92634 (first 60 min) + 92635 (each additional 15 min) | Initial fitting of hearing aids/devices: programming, device analysis, counseling, and patient training. Verification billed separately. |
| Post-Fitting Follow-Up | — | 92636 (first 30 min) + 92637 (each additional 15 min) | Follow-up visit after fitting: physical fit check, device adjustments, patient counseling, training, and troubleshooting. Verification billed separately. |
| Verification (Add-On) | — | +92638 (behavioral) + 92639 (probe-microphone) | Add-on codes for verification procedures: aided speech recognition, soundfield measures, or probe-microphone testing. Must be billed with fitting or follow-up. |
| Standalone Verification / Assistive Technology | — | 92641 (electroacoustic analysis), 92642 (assistive technology fitting) | Standalone verification and fitting services: electroacoustic analysis of devices; fitting/training for assistive technologies (FM/DM systems, remote microphones, alerting devices). |
Lower Extremity Revascularization (LER)
A total of 46 new codes have been introduced, while previous codes have been deleted. These updates show new technology and the shift in care toward outpatient settings.
Proprietary laboratory / advanced diagnostics
27% of the new codes are assigned to proprietary lab tests and specialized molecular diagnostics that form a large block of new CPT additions.
Category III codes
27% of the new Category III codes address AI-assisted imaging, risk scoring, and emerging digital health technologies.
Appendixes Updated
Several existing codes, mainly for behavioral health services, have been added to CPT appendices P and T. These appendices list services delivered via audio-video or audio-only technologies that the CPT Editorial Panel recognizes as equivalent to in-person care.
CMS’ Proposed Rules for 2026
On the reimbursement side, CMS is updating how much physicians and healthcare organizations get paid for services under Medicare. These updates affect the conversion factor, work RVUs, and specialty-specific codes. Here’s a detailed breakdown of the key proposals:
Conversion Factor Updates
Medicare applies a conversion factor to calculate payment rates for services. In 2026, CMS proposes a 2.5% increase, plus a -0.55% adjustment to RVUs. Qualifying APM participants get a slightly bigger increase compared to providers not in APMs. Payments will rise, but the gain depends on whether a provider is part of an APM.
Efficiency Adjustment
CMS assumes that new technologies have made certain services faster or easier for doctors to perform. So, they propose a 2.5% cut in work RVUs for non-time-based services. This lowers reimbursement slightly for those services that show less physician effort required.
Specialty-Specific Valuations
CMS is reevaluating certain specialties, including cardiology and revascularization procedures, and updating Geographic Practice Cost Indices (GPCIs) and malpractice RVUs. This means payment rates may go up or down depending on the specialty and geographic region.
OPPS and ASC Adjustments
CMS proposes a new add-on code under HCPCS for Tc-99m radiopharmaceuticals. Also, expanded hospital price transparency rules are included that require hospitals to share more data on costs and charges. This improves billing accuracy and may affect how outpatient and surgical centers get reimbursed.
How Medical Billers Need to Adapt to the Updates?
The 2026 CPT and CMS updates require medical billers to be aware of these changes beforehand. Adapting to the changes effectively is important to maintaining revenue cycle efficiency. In the following ways, billing teams should adjust:
- Training Workshops: Conduct regular training sessions for billing staff to stay updated on the latest CPT codes and CMS payment policies.
- Stay Ahead on Transparency Rules: Prepare to manage expanded price transparency requirements in billing and reporting for practices linked to hospitals or ASCs.
- Strengthen Documentation Practices: Work with providers to capture accurate clinical documentation that matches the new coding standards.
- Monitor Specialty-Specific Impacts: Pay close attention to areas like cardiology, revascularization, and lab testing, where reimbursement changes may greatly affect revenue.
- Leverage Technology Tools: Use automated coding and billing software that integrates CPT updates to reduce errors and speed up claim processing.
- Regularly Audit Claims: Perform internal audits to find errors early and adjust billing strategies in response to payer feedback.
How Outsourcing Billing Services can help?
It is difficult for practices to manage these changes in-house. In this case, partnering with a professional medical billing company like Transcure is the best decision. They provide the expertise and technology needed to stay ahead of CPT and CMS updates.
| Challenge with 2026 CPT & CMS Updates | How Transcure Helps |
|---|---|
| Frequent CPT code changes | Continuously monitor CMS updates and update coding systems in real time, so practices always bill with the latest codes. |
| New AI-driven and remote monitoring codes need accurate documentation & coding | Train coders on AI, digital health, and remote monitoring services to ensure clean claim submission and compliance with payer rules. |
| CMS Physician Fee Schedule adjustments | Analyze PFS changes annually and adjust billing workflows to reflect new reimbursement rates. |
| Efficiency adjustments (2.5% RVU cuts on certain non-time-based services) | Help providers understand where reimbursement may drop and optimize documentation to avoid underpayments. |
| Specialty-specific revaluations (e.g., cardiology, LER, diagnostics) | Offer specialty-focused billing teams that understand unique code sets and payer policies for each medical field. |
| Expanded hospital & ASC price transparency requirements | Use reporting tools that generate clear financial data, supporting compliance with CMS transparency rules. |
| Risk of revenue loss due to coding errors or denials | Maintain a 98% clean claim rate by using AI-driven claim scrubbing and Robotic Process Automation (RPA) bots. |
| Staff burden in keeping up with compliance training | Provide ongoing coder training and compliance audits so practices don’t have to manage this internally. |
| Need for updated workflows across multiple EHR/EMR systems | Integrate with 30+ EHRs and update templates/workflows so providers’ systems stay aligned with new codes. |
| Preparing for payer audits and future CMS rule changes | Perform proactive claim audits and track payer trends to ensure practices are audit-ready at all times. |
Conclusion
According to the 2026 CPT and CMS updates, the documentation and billing requirements for providers will become more detailed. The new code set has introduced over 400 code changes, new AI, and remote monitoring codes with stricter CMS reimbursement rules. Due to this, practices must be capable enough to adapt to the changes to avoid compliance risks.
However, outsourcing to a trusted partner like Transcure ensures that providers stay ahead of these changes. With real-time coding updates, payer-specific expertise, and AI-powered billing tools, Transcure helps practices maximize reimbursements and remain audit-ready.
Frequently Asked Questions (FAQs)
How often does CMS release new reimbursement rules?
CMS generally releases reimbursement rule updates every year through the annual Medicare Physician Fee Schedule (PFS). These updates may also include mid-year adjustments if new policies or healthcare trends require them.
Where can I find the list of CPT codes?
The complete list of CPT codes is published and maintained by the American Medical Association (AMA). You can access them through the AMA website, licensed coding books, or certified coding software tools.
What are common CPT coding mistakes?
Common mistakes include using outdated codes, under-coding or over-coding services, and mismatching CPT codes with supporting documentation. These errors often lead to claim denials, payment delays, or compliance risks.
What is the role of AMA in updating CPT codes?
The American Medical Association (AMA) is responsible for developing and maintaining CPT codes. AMA reviews healthcare trends, technology, and procedures each year to update codes so that providers, payers, and patients have a standardized language for billing and reporting.
