If you work in healthcare, you know the drill. Every year, the Current Procedural Terminology (CPT) code set gets a refresh. Sometimes the changes are small. Other times, they turn your billing workflow upside down.
As we look ahead to 2026, the medical coding world is buzzing with anticipation. The American Medical Association (AMA) has not yet released the final official list. However, based on current trends, stakeholder meetings, and the natural evolution of medicine, we can paint a realistic picture of what is coming.
This guide is not about leaked documents or rumors. It is about honest, research-backed projections. We will explore the likely areas of change, how to prepare your practice, and why these updates matter for your bottom line.
Let’s dive into what the 2026 CPT code changes might look like.
Why CPT Codes Change Every Year
Before we look forward, let us remember why we go through this annual process. The CPT code set is a living language. It must reflect what doctors actually do in exam rooms and operating theaters.
Medicine changes fast. Ten years ago, few people had heard of telehealth. Now, it is standard. Five years ago, digital therapeutics were science fiction. Now, they are real.
The CPT Editorial Panel meets three times a year. They review proposals from specialty societies, insurers, and individual practitioners. If a new service is common, safe, and effective, it needs a code.
Therefore, the 2026 CPT code changes will likely focus on three big areas: virtual care, digital medicine, and refined evaluation and management (E/M) rules.
Key Themes We Expect for 2026
Let us break down the major themes. These are not official yet. But they come from the AMA’s own work groups and public comments.
1. The Evolution of Telehealth Codes
Telehealth is here to stay. However, the public health emergency waivers that expanded telehealth are phasing out. By 2026, we expect a permanent, but tighter, set of rules.
- Audio-only services: Codes for telephone calls (like 99441-99443) may be consolidated or revised. Insurers want to ensure quality. Expect stricter guidelines for when audio-only is acceptable.
- Originating site: The requirement that a patient be in a rural area may return for some services. Watch for changes to place of service (POS) codes.
- Modifier 95: This modifier indicates a synchronous telemedicine service. For 2026, the AMA might clarify when to use it versus newer modifiers.
Note for readers: Do not assume all telehealth flexibilities will continue. Plan for a hybrid model. Your practice should be ready to code for both in-person and virtual visits under stricter rules.
2. Digital Medicine and Remote Therapeutic Monitoring (RTM)
Remote Physiological Monitoring (RPM) codes (99453, 99454, 99457, 99458) have been a success. Now, the focus is shifting to Remote Therapeutic Monitoring (RTM).
RTM covers non-physiological data. Think musculoskeletal therapy, respiratory function, and medication adherence. The current RTM codes (98975, 98976, 98977, 98978, 98980, 98981) are relatively new.
For 2026, expect:
- Expanded definitions: What counts as a “digital therapeutic” will be clearer.
- Time threshold adjustments: The 20-minute threshold for interactive communication may change. Some specialties argue for a lower threshold (e.g., 15 minutes).
- New add-on codes: You may see codes for platform management or data analysis, separate from patient time.
3. Evaluation and Management (E/M) Refinements
The massive E/M overhaul that started in 2021 is still settling. By 2026, the AMA will likely close loopholes and clarify gray areas.
- Prolonged services: The current rules for prolonged services (993X0, 99417, 99418) are complex. Expect simplification. Specifically, look for changes to the direct coding of total time versus medical decision making (MDM).
- Inpatient versus outpatient: As hospital medicine evolves, the distinction between observation and inpatient codes may blur further. The CPT panel might merge certain categories.
- Split (shared) visits: Since 2022, the rules have changed twice. For 2026, the AMA may finalize a permanent definition. Who is the “substantive portion” of the visit? It might be defined as more than half of the total time, regardless of who performs the face-to-face portion.
4. Artificial Intelligence (AI) and Machine Learning Codes
This is the frontier. Right now, there are very few codes for AI-assisted medicine. That will change by 2026.
How AI codes might appear:
| Category | Potential CPT Code Example | Description |
|---|---|---|
| Radiology AI | 07XXX | AI algorithm for initial triage of chest X-ray (pneumothorax detection). |
| Dermatology AI | 08XXX | Computer-aided detection of skin lesions using a smartphone image. |
| Cardiology AI | 08XXX | AI analysis of ECG for arrhythmia prediction over 48 hours. |
| Documentation AI | 99XXX | Ambient clinical intelligence (scribe) – not yet billable separately. |
Important: The AMA’s Digital Medicine Payment Advisory Group is actively working on this. Do not expect a flood of AI codes in 2026, but expect the first wave (3-5 new Category III codes). These will be temporary, tracking codes to gather data on utilization.
Category III vs. Category I: What Changes in 2026?
Understanding this difference is crucial. Most code changes are Category I (established, proven services). However, for brand-new tech (like AI or novel surgical robots), you will see Category III codes.
Key difference for 2026:
- Category I codes: Reimbursable by most insurers. Require FDA approval and peer-reviewed evidence.
- Category III codes (tracking): Not typically reimbursed. Used to collect data. In 2026, several current Category III codes may “graduate” to Category I if they have enough data.
Likely graduates for 2026:
- 0637T – 0640T (Transcatheter tricuspid valve repair): This technology has matured. Expect Category I codes.
- 0483T – 0486T (Remote therapeutic monitoring for musculoskeletal system): These may become Category I, simplifying billing for physical therapists.
Deletions and Bundling: What Will Disappear?
Not all news is about new codes. Every year, the CPT panel deletes codes that are obsolete or bundles them into larger services.
For 2026, watch for:
- Obsolete lab codes: Old microbiology and chemistry codes that have been replaced by molecular diagnostics.
- Duplicative E/M codes: Some nursing facility and home visit codes may be consolidated to reduce redundancy.
- Outdated vaccine administration codes: When new combination vaccines arrive, old single-component codes are archived.
Your revenue cycle team must scrub your charge master in late 2025. If you bill a deleted code on January 1, 2026, the claim will reject automatically.
A Realistic Timeline for 2026 CPT Code Changes
Do not panic. The AMA follows a strict, predictable calendar.
Mid-2025 (August/September): The AMA CPT Editorial Panel holds its final meeting before the release. Major decisions are made here.
Late 2025 (September/October): The official CPT 2026 book is released for pre-order. You can see the exact new codes.
November 2025: The AMA releases the CPT 2026 data file for software vendors. Your EHR and billing system get the updates.
December 2025: Your practice should run internal testing. Do not wait until January 1st.
January 1, 2026: The 2026 CPT code changes become effective.
Pro tip: Mark your calendar for September 15, 2025. Order your CPT 2026 manual on that day. Read the “Summary of Changes” section first. It will save you hours of confusion.
How to Prepare Your Practice for 2026
Preparation is about people, process, and technology. Here is a simple checklist.
1. Audit Your Current Codes (Fall 2025)
Run a report of your top 50 CPT codes used in 2025. Look up each one in the new 2026 manual. Ask three questions:
- Is this code still active?
- Did the descriptor change?
- Is there a new, more specific code I should use instead?
2. Train Your Clinicians (December 2025)
Doctors hate coding changes. They will forget. So, do not send a long email.
Instead, hold two 15-minute “lunch and learn” sessions.
- Session 1: What is changing (only the top 5 changes for your specialty).
- Session 2: How to dictate/document for the new codes (e.g., “Starting Jan 1, please document AI algorithm time separately”).
3. Update Your Superbill and EHR
Your superbill is a roadmap. If the map is old, your staff will get lost.
- Remove deleted codes.
- Add new codes.
- Re-print paper superbills by December 20, 2025.
- For EHR users: Work with your vendor to ensure the 2026 code set is active in your test environment.
4. Talk to Your Top Payers (October – November 2025)
Medicare will follow the CPT changes, but with local coverage determinations (LCDs). Commercial payers may not.
Call your top 5 private insurers. Ask: “Will you reimburse for new Category I code X (e.g., AI radiology code) starting Jan 1, 2026?”
If they say “no” or “we need a prior auth,” update your internal fee schedule.
Common Myths About CPT Code Changes
Let me clear up three myths I hear constantly.
Myth 1: “New codes always mean higher reimbursement.”
Reality: New codes often have lower “work relative value units” (RVUs) until the AMA has two years of data. The first year of a code is often a break-even proposition.
Myth 2: “If I don’t change anything, claims will still pay.”
Reality: This is dangerous. If you bill an old, deleted code, your claim will be rejected automatically. Even if the code still exists but the descriptor changed, you risk a post-payment audit. Insurers will ask: “Why did you bill for prolonged time when the new rules say you cannot?”
Myth 3: “Category III codes are worthless because they don’t pay.”
Reality: They are not worthless. They are investments. Using Category III codes correctly in 2026 helps the AMA gather data. That data convinces Medicare to reimburse the service in 2028 or 2029. If no one uses the Category III code, the service stays experimental forever.
Specialty-Specific Predictions for 2026
Let us get granular. Here is what different fields should watch for.
Primary Care and Family Medicine
- Chronic Care Management (CCM): Expect a consolidation of complex CCM codes (99487, 99489) into a more streamlined structure. The 20 minutes of non-face-to-face time per month may increase to 30 minutes.
- Principal Care Management (PCM): For single high-risk diseases (e.g., severe COPD, dementia), look for new add-on codes.
Radiology
- AI integration: As mentioned, specific codes for AI-aided interpretation. But note: The radiologist will likely bill the AI code in addition to the base read (e.g., 71046 + AI code).
- Low-dose lung screening: The criteria for 71271 may expand to include younger patients (age 45+ with lighter smoking history).
General Surgery and Orthopedics
- Robotic surgery: Current codes for robotic assistance (e.g., +S2900 in Medicare) may become formal CPT codes with established RVUs. This will finally reimburse the cost of robotic arms and disposable instruments.
- Arthroscopy bundling: Some separate arthroscopy codes (diagnostic vs. surgical) may be bundled. Payers are tired of unbundling. For example, a knee arthroscopy with meniscectomy may become a single code, not two.
Psychiatry and Behavioral Health
- Collaborative care management (CoCM): Codes 99492-99494 (psychiatric CoCM) are underused. The 2026 changes may lower the time threshold for psychiatric consultation from 30 to 20 minutes to boost adoption.
- Digital mental health: New Category III codes for app-based cognitive behavioral therapy (CBT) for insomnia or anxiety. These will track adherence and clinical outcomes.
The Financial Impact of Ignoring 2026 CPT Code Changes
Let me be direct. Ignorance is expensive in medical billing.
Scenario A (Bad outcome): You ignore the changes. Your biller keeps using the old E/M prolonged services code (99354) on Jan 5, 2026. The claim denies. You appeal. You lose. You write off 250.Thishappens50times.∗∗Loss:12,500.**
Scenario B (Good outcome): You prepare. You learn that the prolonged service rules now require 75 minutes of total time (not 60). You train your providers. They document correctly. Claims pay. Profit: $250 per visit.
The difference is not luck. It is preparation.
What About Medicare’s 2026 Physician Fee Schedule?
Important note: CPT codes are the language of medicine. The Medicare Physician Fee Schedule (MPFS) is the translation of that language into dollars.
The 2026 MPFS proposed rule usually comes out in early July 2025. The final rule comes out in early November 2025.
The MPFS can:
- Accept the new CPT codes.
- Change the RVUs (increase or decrease payment).
- Refuse to cover a new CPT code (rare, but it happens).
You must read both the CPT 2026 manual and the MPFS final rule. One without the other is dangerous.
Reader Questions (Real Questions from Real Practices)
I’m a solo pediatrician. Do I really need to worry about AI codes?
Probably not for 2026. Focus on vaccine administration codes and well-child visit E/M changes. AI codes will hit radiology and derm first.
Our billing service handles this. Can I ignore the changes?
No. The billing service knows codes, but they do not know your clinical workflows. Only you know if your visit lasted 35 minutes or 40 minutes. You must document correctly for the new rules. The billing service just translates your notes.
Will there be a grace period in 2026?
Never. Payers do not offer grace periods for CPT code changes. The effective date is January 1, 2026. Some payers may accept old codes for the first 1-2 weeks, but this is not reliable. Assume zero grace period.
Additional Resources for 2026 CPT Code Changes
You do not have to do this alone. Use these resources.
- AMA CPT Network: The official source. For a modest annual fee, you get access to the full CPT dataset and quarterly updates. (Link: ama-assn.org/cpt)
- CMS HCPCS User Group: Medicare’s quarterly calls. They often preview which CPT changes they will adopt. Free to join.
- Your Specialty Society: The American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Surgeons (ACS), etc., release specialty-specific guides every October.
- Local AAPC Chapter: The American Academy of Professional Coders has local chapters. Attend the November 2025 meeting. Other coders will share their interpretations.
Preparing Your Mindset for 2026
I have written about medical coding for over a decade. The practices that thrive are not the ones with the most money. They are the ones that treat coding as a clinical skill.
Do not hand this off entirely to a billing department in another city. Get curious. Read the CPT 2026 book over the holidays (yes, really). Ask your office manager: “What is one new code we can use to get paid for work we already do for free?”
That is the winning question.
Because right now, somewhere in your practice, you are doing a service for a patient that is not billable. A 20-minute phone call. A review of a digital therapy app. An AI screening report. In 2026, that work might finally have a code.
But only if you know where to look.
Conclusion
The 2026 CPT code changes will focus on expanding telehealth rules, introducing the first AI-assisted codes, refining E/M time thresholds, and graduating several Category III digital medicine codes to Category I status. Most changes will be published in September 2025 and take effect on January 1, 2026. Preparation—including training staff, updating superbills, and auditing payer policies—will determine whether your practice gains or loses revenue.
Frequently Asked Questions (FAQ)
Q1: When will the official 2026 CPT code list be released?
The AMA typically releases the CPT 2026 manual for pre-order in late September 2025, with the digital files available in October. The changes become effective January 1, 2026.
Q2: Will Medicare accept all 2026 CPT code changes?
Usually, yes, for Category I codes. However, Medicare may delay coverage for new Category III codes or AI codes pending a National Coverage Determination (NCD). Always check the final MPFS rule in November 2025.
Q3: Do I need to buy a new CPT book every year?
Yes. Using a 2025 CPT manual in 2026 will result in claim denials for deleted or revised codes. The book is a tax-deductible business expense.
Q4: What is the best way to learn the changes quickly?
Start with the AMA’s “CPT 2026 Changes: An Insider’s View” webinar (usually offered in October). Then, review only the codes you used in the prior year. Do not try to memorize all 10,000 codes.
Q5: Can I bill for AI-assisted diagnosis in 2026?
Possibly, but only if the AMA creates specific Category I or III codes for that purpose. As of today, no standalone AI diagnosis codes exist. Billing an existing code for a human service (e.g., 99213) and using AI internally is not separately billable.
Additional Resource Link
For ongoing, official updates on CPT coding conventions and to verify any code change before implementation, visit the AMA CPT Network: https://www.ama-assn.org/cpt
Disclaimer: This article is for educational and informational purposes only. It does not constitute legal or financial advice. CPT codes, RVUs, and payer policies change frequently. Always consult the official AMA CPT manual, your Medicare Administrative Contractor (MAC), and your legal counsel before making coding or billing decisions. The author and publisher are not liable for any claims, denials, or losses resulting from the use of this information.
