The start of the Federal Fiscal Year on October 1 ushered in significant ICD-10 updates and changes to several major Prospective Payment Systems (PPS). But while October 1 represents the first major milestone in “Coding Season,” implementation is only the beginning. Now is the time for organizations to assess compliance, identify potential gaps, and evaluate how successfully the latest ICD-10 and applicable PPS changes have been incorporated into day-to-day workflows.
And the next wave of change is quickly approaching. On January 1, HCPCS and CPT coding changes will take effect, along with annual updates to the remaining calendar-year prospective payment systems and fee schedules.
Although definitive details surrounding the upcoming CMS HCPCS changes are not yet available, organizations do not need to wait to start preparing. The 2027 AMA CPT changes are already on the horizon, bringing 299 new codes across the Medical, Surgical, and Diagnostic sections, 80 deleted codes, numerous revisions to code descriptions (Short, Medium, Long, Clinician and Consumer-friendly), and hundreds of guideline updates.
Among the significant CPT changes coming in 2027 are:
Maternity Care and Delivery Services
A major restructuring of maternity care and delivery services is planned this year, shifting from long-standing global obstetric reporting to a model that supports separate reporting by phase of care.
Key changes include:
- Deletion of comprehensive global routine obstetric care codes, that previously bundled antepartum, delivery and postpartum care;
- Separately reportable antepartum care visits with Evaluation & Management (E/M codes);
- New initial and subsequent day labor management codes, reported on a per day basis;
- New delivery codes; and
- Separately reportable postpartum care based on E/M guidelines.
Skin Cell Suspension Autografts
Comprehensive Skin Cell Suspension Autograft (SCSA) coding now encompasses the harvesting, preparation of harvest, application of the SCSA and dressing. Key changes include:
- Deletion of the prior Harvest, Preparation and Application codes; and
- Replacement with SCSA codes by anatomic area and treatment size, with reporting for the first and each additional 100 sq cm (or per 1% body area for infants/children).
- Trunk, Arms, and/ or Legs
- Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet, and/or Multiple Digits
Cardiac Contractility Modulation
Establishment of permanent Cardiac Contractility Modulation (CMM) system codes, replacing prior new technology codes.
- Removal
- Insertions
- Repositioning/ Relocation
- Programming
- Interrogation
Unattended Sleep Studies
Revision to unattended sleep study codes to support current technologies used.
- Deletion of prior unattended sleep study codes
- Creation of new unattended sleep study codes, defined by complexity of channels and parameter categories
- New interpretation and reporting codes by defined complexity and parameter categories
Diaphragmatic Hernia Repairs
Expanded hernia repair codes for reporting diaphragmatic hernias.
- New codes for both traumatic and non-traumatic repair of diaphragmatic hernias based on route
- Open
- Laparoscopic
- Thoracoscopic
- New mesh/ prosthesis insertion code.
Call to Action!
There is no need to wait for all the pieces to fall into place before preparing for January 1. As CMS finalizes the calendar-year payment system updates and releases its HCPCS changes, organizations can get ahead by:
- Assess the impact of the CPT updates to your organization or practice, including the presence of codes in your Charge Description Master (CDM), ordering processes and charge capture workflows.
- Review reporting guidance of new and revised codes and develop or update workflows to support accurate coding and reporting.
- Evaluate documentation requirements to ensure clinical documentation supports the services reported.
- Plan targeted role specific education for medical staff, other clinicians, coding professionals, and charge capture teams to support a smooth and compliant transition.
While HCPCS and prospective payment system changes will require the same level of assessment and preparation, successful Coding Season readiness starts well before the effective date. MediRegs users can take a proactive approach with pre-release codebooks, advance guidance, and customizable news alerts that help teams monitor emerging changes, begin planning earlier, and avoid losing valuable implementation time waiting for or potentially missing critical updates.