Every year, two critical code set updates reshape how medical practices document and bill for services. Miss them, and your claims start getting denied for reasons that have nothing to do with the quality of care your practice provides — the codes you used simply no longer exist, or new ones have replaced them and payers expect the updated versions.
For 2026, the updates are substantial. The CPT code set saw its largest overhaul in recent memory, and the ICD-10-CM diagnosis codes received hundreds of additions targeting greater clinical specificity. If your billing team has not fully reviewed and implemented these changes, revenue is almost certainly slipping through the cracks right now.
This guide covers everything your practice needs to know about the 2026 CPT and ICD-10-CM updates — what changed, why it matters, and what to do about it.
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## Part 1: CPT 2026 Updates (Effective January 1, 2026)
The American Medical Association (AMA) released the CPT 2026 code set with **418 total changes** — including **288 new codes, 84 deletions, and 46 revisions**. This is one of the most significant annual updates in recent years, touching virtually every section of the CPT codebook.
Using a deleted code after January 1, 2026 will result in an automatic claim rejection. Using an old code where a new, more specific one now exists may result in a denial for lack of specificity or incorrect coding. Both cost your practice time and money.
Here are the key areas every outpatient and specialty practice needs to know:
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### 1. Remote Patient Monitoring (RPM) — Significant Expansion
Remote patient monitoring received a major overhaul in 2026, recognizing that effective monitoring does not always require a full 30 days of data collection.
**What changed:**
– **Two new codes added:** 99445 (device supply for remote monitoring) and 99470 (initial treatment management)
– **Shorter monitoring periods now reimbursable:** New codes cover remote monitoring over **2–15 days within a 30-day period** — previously, a full month of data was required
– **Existing codes revised:** 99453, 99454, 99457, and add-on code +99458 have been revised to align with modern device usage and updated documentation requirements
– Treatment management is now billable after just **10 minutes per month**
**What this means for your practice:** If you offer remote physiologic monitoring, telehealth, or chronic care management services, your billing team must update their code mapping immediately. Practices still using the old RPM code structure are either underbilling (missing the new shorter-duration codes) or submitting codes that have been revised and may not process correctly.
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### 2. AI-Assisted Diagnostic Services — New Category I Codes
For the first time, the CPT code set includes **Category I codes** (permanent, reimbursable codes) for services where artificial intelligence directly supports clinical decision-making.
**New AI codes include:**
– Coronary atherosclerotic plaque assessment using AI analysis
– Perivascular fat analysis for cardiac risk assessment
– Multispectral imaging analysis for burn wound evaluation
– ECG algorithmic analysis codes (0902T, 0903T–0905T)
– Algorithm-assisted detection of cardiac dysfunction
**What this means for your practice:** Cardiology, radiology, and dermatology practices that use AI-enabled diagnostic tools now have legitimate CPT codes to bill for those services. If your practice uses any software-assisted diagnostic analysis, check whether a new 2026 Category I or Category III code covers it.
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### 3. Lower Extremity Revascularization — Complete Code Restructuring
This is one of the most significant structural changes in CPT 2026 and affects vascular surgery and interventional cardiology practices directly.
**What changed:**
– Codes **37220–37235 have been deleted entirely**
– Replaced by **46 new codes** organized by anatomical “territory” and type of treatment
– New structure groups codes by the specific vessel territory treated and the intervention performed (angioplasty, stenting, atherectomy)
**What this means for your practice:** Any practice billing lower extremity vascular procedures must completely retire their old code crosswalks for 37220–37235 and remap every procedure to the new code family. Submitting deleted codes will result in immediate rejection.
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### 4. Audiology and Hearing Device Services — Full Replacement
Legacy codes for hearing aid and hearing device services have been completely retired and replaced.
**What changed:**
– Codes **92590–92595 have been deleted**
– Replaced by a new family of **12 codes (92628–92642)** covering the full care pathway: candidacy evaluation, device selection, fitting, and follow-up
– New code 92628 covers the first 30 minutes of hearing-aid candidacy evaluation, with time-based add-on code 92629
**What this means for your practice:** Audiology practices and ENT practices that provide hearing aid services must update all charge master entries, encounter form templates, and billing system crosswalks for these services before submitting any 2026 claims.
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### 5. Surgical Updates Across Multiple Specialties
Several high-impact surgical code changes affect common outpatient procedures:
**Prostate Biopsy (Urology):**
– Codes 55705–55715 now require specification of the **approach** (transrectal vs. transperineal) and **guidance type** (ultrasound vs. MRI-fusion)
– Vague, non-specific biopsy coding is no longer acceptable — documentation must support the approach and guidance method used
**Endoscopic Sleeve Gastroplasty (General Surgery/Bariatric):**
– New code **43889** established for gastric restrictive procedure via transoral endoscopic sleeve gastroplasty, replacing the retired Category III code 0600T
**Percutaneous Lumbar Decompression (Spine/Neurosurgery):**
– New codes **62330/62331** for percutaneous lumbar decompression via partial removal of ligamentum flavum with image guidance
– New add-on code **+63032** for annular defect repair with a bone-anchored closure device
**Carpal Tunnel (Orthopedics/Hand Surgery):**
– New code **64728** for percutaneous balloon decompression of the median nerve in carpal tunnel syndrome, including ultrasound guidance
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### 6. Laboratory and Pathology — PLA Code Expansion
Proprietary Laboratory Analyses (PLA) codes account for approximately 27% of all new CPT codes in 2026 — the largest single category of new codes.
**Key changes:**
– Codes 0450U and 0451U deleted
– New PLA codes added in the 0575U–0599U range
– New infectious disease panels: **87494** (STI multiplex panel) and **87812** (SARS-CoV-2/influenza antigen combination)
**What this means for your practice:** If you order or bill laboratory tests, confirm that any PLA codes you use are still valid for 2026 and that your lab has updated to the new panel codes where applicable.
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## Part 2: ICD-10-CM FY2026 Updates (Effective October 1, 2025)
The ICD-10-CM FY2026 update, released by CMS on June 9, 2025 and effective **October 1, 2025**, introduced **487 new diagnosis codes, 38 revisions, and 28 deletions** — nearly double the number of new codes compared to the prior year. These updates apply to all patient encounters from October 1, 2025 through September 30, 2026.
If your practice has not reviewed these updates, any claims submitted since October 1, 2025 using deleted codes or failing to use new, more specific codes may be at risk of denial or audit.
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### 1. Diabetes — New Remission Code (E11.A)
One of the most clinically significant additions in FY2026 is a new code for type 2 diabetes in remission.
**New code:** **E11.A** — Type 2 diabetes mellitus without complications, in remission
**New guideline:** Assign E11.A when the provider’s documentation explicitly states the diabetes mellitus is **”in remission.”** If the documentation says “resolved,” that is not the same as remission — the provider must be queried for clarification before this code can be assigned.
**What this means for your practice:** Endocrinology, primary care, and internal medicine practices will encounter this regularly. Ensure your physicians understand the documentation distinction between “resolved” and “in remission” — it directly impacts code assignment and risk adjustment.
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### 2. HIV Coding — Major Guideline Revisions
The FY2026 guidelines include the most significant revisions to HIV coding sequencing in several years.
**Key changes:**
– Updated clarification on when to use **B20** (HIV disease) versus **Z21** (asymptomatic HIV infection status)
– One new guideline added and eight existing guidelines revised
– Enhanced direction on sequencing HIV-related conditions and comorbidities
**What this means for your practice:** Infectious disease, primary care, and internal medicine practices treating HIV patients must review the updated sequencing guidelines. Incorrect sequencing between B20 and Z21 can affect reimbursement, risk adjustment scores, and compliance.
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### 3. Non-Pressure Chronic Ulcers — Over 100 New Codes
Chapter 12 (Diseases of the Skin) received the largest single chapter expansion in FY2026, with more than **100 new codes** for non-pressure chronic ulcers.
**What changed:**
– New codes now classify chronic ulcers by **anatomical site** and **severity**
– Laterality (left vs. right) is now required for many ulcer codes
– New abdominal and pelvic pain codes also specify laterality, including flank pain/tenderness and pelvic/perineal pain
**What this means for your practice:** Wound care, vascular, dermatology, and podiatry practices must code ulcers to the highest level of specificity including site and severity. Unspecified ulcer codes where a more specific one exists will trigger medical necessity scrutiny and potential denial.
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### 4. Neurological Conditions — New Specificity Codes
The neurology section received meaningful additions:
– New codes for **primary progressive apraxia of speech**
– New codes for **multiple sclerosis subtypes** — greater specificity between relapsing-remitting, primary progressive, and secondary progressive MS
– New codes for **muscular dystrophy variants**
– New codes for **beta-amyloid and tau protein testing** (82233, 82234, 84393, 84395) supporting expanded evaluation of dementia and neurodegenerative diseases
**What this means for your practice:** Neurology practices must code to the specific MS subtype when documented. Dementia and memory care practices now have specific lab codes for biomarker testing used in Alzheimer’s evaluation.
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### 5. Oncology — Chemotherapy Encounter Sequencing Clarified
A revised guideline now provides explicit instruction for encounters where the primary purpose is administration of cancer treatment.
**New guideline:** When the main purpose of the encounter is to administer chemotherapy, immunotherapy, or external beam radiation therapy, assign a **Z51.- encounter code as the first-listed diagnosis** — not the cancer diagnosis.
If a patient receives more than one type of antineoplastic therapy in the same session, both Z51.0 and codes from subcategory Z51.1- may be assigned together, with one reported as secondary.
**What this means for your practice:** Oncology practices and infusion centers must review their encounter coding workflows to ensure Z51.- codes are correctly sequenced as primary when treatment administration is the reason for the visit.
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### 6. Other Notable ICD-10-CM Additions
– **Inflammatory breast cancer:** New designation added for more precise classification of malignant neoplasms of the breast
– **Eye and adnexa:** New codes for eyelid inflammation by location and thyroid orbitopathy
– **Infectious disease:** New codes for Demodex mite infestation with corresponding blepharitis codes
– **Genetic susceptibility codes** expanded to include fallopian tubes, urinary tract, digestive system, and colorectal cancer risk
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## What Your Practice Should Do Right Now
If your billing team has not yet completed a full review of the 2026 CPT and ICD-10-CM changes, here is a prioritized action plan:
**For CPT 2026 (January 1, 2026 — already in effect):**
1. Pull your top 50 most frequently billed CPT codes and cross-reference each against the 2026 changes list
2. Identify any deleted codes your practice uses and map them to their 2026 replacements immediately
3. Update your charge master, encounter forms, and EHR templates
4. Review RPM code changes if your practice offers remote monitoring services
5. Verify with your EHR and billing software vendor that the 2026 CPT data file has been loaded
**For ICD-10-CM FY2026 (October 1, 2025 — already in effect):**
1. Review the new E11.A diabetes remission code and train physicians on the documentation requirement
2. Update HIV coding workflows to reflect the revised sequencing guidelines
3. Ensure wound care and ulcer coding reflects the new specificity requirements
4. If you treat oncology patients, verify your encounter sequencing for chemotherapy visits
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## The Bottom Line
Coding updates are not optional — using deleted codes or failing to apply new specificity requirements is a compliance issue, not just a billing inconvenience. Under HIPAA, using the current, accurate code set is a legal requirement. Outdated coding leads to claim denials, payment delays, and audit exposure.
The good news is that staying current with coding updates is manageable when you have a systematic review process and the right billing partner.
At **ClaimsXperts**, our coding team reviews every annual CPT and ICD-10-CM update and proactively updates our workflows before each effective date. Our clients do not experience denials because a code changed — because we handle that before a single claim goes out the door.
[**Contact us today**](https://www.rcmmasters.com/#contactus) to learn how ClaimsXperts keeps your practice coding-compliant and revenue-protected year-round.
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*ClaimsXperts is a Revenue Cycle Management company based in Frisco, TX, serving medical practices across the United States. We specialize in medical billing, coding, and insurance credentialing for solo practitioners, group practices, and specialty clinics.*