Now that October 1—the start of the Federal Fiscal Year—has passed, it’s time to prepare for additional standard code set changes effective January 1, 2026. These include updates to Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Current Dental Terminology (CDT) codes, along with several pending payment system updates. Despite challenges such as the government shutdown, delays in final rules, and uncertainty around telemedicine coverage, this remains a critical period for planning ahead of the January 1 implementation.
The American Medical Association (AMA) has released 288 new CPT codes for CY2026. Over a quarter of these additions relate to new technology, and another quarter pertain to proprietary laboratory analyses (PLA). Additional changes impact remote patient monitoring, artificial intelligence (AI) applications, revascularization procedures (now including image guidance, as well as supervision and interpretation), image guided prostate biopsies, other prostatic procedures and audiologic/hearing device services. According to the AMA, many of these updates reflect emerging technologies and the growing role of AI in improving patient care.
Conversely, 84 CPT codes will be deleted, primarily in similar areas such as PLA and new technology codes, as well as prior codes related to revascularization procedures and hearing devices. In addition, there are approximately 46 CPT code revisions slated for next year.
On the dental front, the American Dental Association has announced 60 CDT code changes for 2026, including 31 new codes, 6 deletions, and 14 revisions, along with several editorial updates.
Although the Medicare Physician Fee Schedule (PFS) Final Rule was recently released, several payment system updates delayed by the prior government shutdown. These include the Hospital Outpatient Prospective Payment System (OPPS) Final Rule, including decisions to phase out the Inpatient Only list, virtual direct supervision for certain services, and payment for skin substitute products, and the release of the 2026 HCPCS code set from CMS.
The PFS Final Rule introduced several key changes, including:
- Multiple conversion factors based on participation in alternative payment models
- Updates to geographic practice cost indices (GPCI) and malpractice RVUs
- Revised efficiency adjustments using the Medicare Economic Index (MEI) for applicable HCPCS codes
- Updates to practice expense RVUs to better align with clinical practices
- Allowance for direct supervision via real-time audio/visual telecommunications for certain services
- Payment for skin substitute products in non-facility settings
With these changes—and more on the horizon—plus a potentially shortened implementation period, it’s essential to stay ahead and streamline your processes. MediRegs supports your change management initiatives in multiple ways:
Current Awareness: Stay informed with standard and customizable news alerts delivered directly to your inbox—so you never miss a change. For example, receive custom alerts on payment rule finalization.
Change Analysis: View Change Reports and a Deleted Code Mapping, available to users in the MediRegs HCPCS and CPT Codebook; instantly identify updates in the CFR, CMS Manuals, NCDs, LCDs, and Coding Articles using Change Analyzers, or model reimbursement impacts with Medicare Reimbursement Calculators—saving time and resources.
Coding and Reimbursement Analysis: Visualize 2026 code updates in our codebooks, review coding edits with the Code Pair Check Tool, and assess payment updates to project reimbursement impacts—ensuring accuracy and fiscal stewardship.
Policy Update: Use the latest content and notifications to trigger timely policy reviews. Change Analyzers help identify updates that can be seamlessly integrated into your policies—streamlining workflows.
Educate: Leverage the latest content and coding updates to launch annual education programs ahead of effective dates—socializing changes across your organization to ensure compliance.
MediRegs is a trusted partner to organizations nationwide—especially during this season of change.
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