9 Min Read
SaMeD RCM Solutions Team
Medical coding continues to evolve as healthcare services, technology, and reporting requirements change. For medical practices, staying informed about upcoming coding changes is essential for accurate claims, compliant documentation, and timely reimbursement.
As we approach 2026, important updates have been announced for the CPT® 2026 code set, while the FY 2026 ICD-10-CM code set and October 2025 HCPCS updates are already in effect.
In this article, we review the major coding developments available as of November 5, 2025, and explain what medical practices should do to prepare for the upcoming 2026 coding year.
The American Medical Association (AMA) released the CPT 2026 code set on September 11, 2025.
The new code set includes 418 total changes, consisting of:
The new Category I CPT codes are scheduled to become effective January 1, 2026.
The updates reflect advances in medical, surgical, diagnostic, and digital healthcare services. Several important areas deserve attention from medical practices and billing teams.
Five new CPT codes have been introduced for remote patient monitoring services involving shorter monitoring periods of 2–15 days within a 30-day period.
Two additional codes address remote monitoring treatment management after 10 minutes of service per calendar month, compared with the previous 20-minute threshold.
These changes recognize the growing role of technology in monitoring and managing patients outside traditional clinical settings.
What practices should review:
The CPT 2026 code set includes new codes for certain services involving augmented and assistive artificial intelligence.
Examples include services involving coronary plaque assessment, perivascular fat analysis for cardiac risk, multispectral imaging for burn wounds, and detection of cardiac dysfunction.
These developments reflect the increasing use of AI-supported technology in clinical assessment and diagnostic services.
Practices should review the applicable code descriptions and reporting instructions before billing these services.
Twelve new codes have been introduced for hearing device-related services.
The updates address patient-centered activities such as assessing individual needs, validating device performance and sound quality, and providing training and support for patients using connected devices.
Audiology and hearing-related practices should review the new code descriptions and applicable documentation requirements before the January 2026 implementation date.
The CPT 2026 code set includes a comprehensive update to lower-extremity revascularization coding.
The previous code structure has been modernized, with 46 new codes introduced in this area to reflect changes in technology and care delivery.
Vascular and surgical practices should review the revised code structure, documentation requirements, and applicable reporting instructions before submitting claims using the new codes.
Important: CPT 2026 codes should not be applied to dates of service before their applicable effective date. Practices should prepare their systems and workflows ahead of January 1, 2026.
Unlike CPT, ICD-10-CM follows a federal fiscal-year schedule. The FY 2026 ICD-10-CM code set became effective October 1, 2025, and applies to healthcare services provided from October 1, 2025, through September 30, 2026.
The FY 2026 release replaces the previous FY 2025 code set for services beginning October 1, 2025.
Medical practices should make sure their billing and electronic health record systems are using the appropriate FY 2026 files.
Areas to review include:
Since FY 2026 is already in effect, practices should confirm that:
Using outdated diagnosis codes can contribute to claim rejections, denials, and reimbursement delays.
HCPCS Level II codes are used to report products, supplies, equipment, certain drugs, and services that may not be represented by CPT codes.
CMS publishes HCPCS Level II updates quarterly. The October 2025 Alpha-Numeric HCPCS file was available before November 5, 2025, and is an important resource for practices preparing claims for the final quarter of 2025.
Billing and coding teams should review the applicable update for:
Practices should also prepare to review the next quarterly release when it becomes available.
Practice takeaway: Do not assume that HCPCS codes remain unchanged throughout the year. Check the official CMS quarterly files and confirm that the code selected is valid for the date of service.
The National Correct Coding Initiative (NCCI) helps promote correct coding methodologies and prevent improper payments.
CMS released the fourth-quarter 2025 NCCI Procedure-to-Procedure (PTP) edits, Version 31.3, effective October 1, 2025.
These edits are important for practices and billing teams because incorrect code combinations or unsupported modifier use may result in claim denials or payment adjustments.
Review the applicable:
Practices should ensure their billing systems and claim review processes reflect the applicable NCCI edits.
New codes and revised reporting requirements make accurate clinical documentation even more important.
A code must be supported by the medical record, and the documentation should clearly reflect the service provided.
Common areas requiring attention include:
Incomplete documentation or incorrect code selection can contribute to claim rejections, denials, payment delays, and compliance concerns.
A structured preparation process can help practices reduce coding errors and avoid unnecessary reimbursement delays.
Coding accuracy is directly connected to the financial performance of a medical practice.
Incorrect or outdated codes, missing modifiers, insufficient documentation, and failure to follow payer requirements can lead to:
Regular coding reviews and timely denial follow-up can help practices identify issues, correct errors, and improve revenue cycle performance.
Keeping up with coding changes is only one part of an effective revenue cycle management strategy. Medical practices also need reliable billing processes, accurate claim submission, denial follow-up, and ongoing accounts receivable management.
SaMeD RCM Solutions LLC supports healthcare practices with services designed to improve billing accuracy and revenue cycle performance, including:
Our goal is to help medical practices improve claim accuracy, reduce avoidable denials, and maintain a more efficient revenue cycle.
Need help reviewing your practice’s coding and billing processes? Request your free Practice Revenue Assessment to identify potential billing gaps and opportunities for improvement.
The new Category I CPT 2026 codes are scheduled to become effective January 1, 2026.
The AMA announced 288 new codes, along with 46 revised codes and 84 deleted codes.
FY 2026 ICD-10-CM became effective October 1, 2025, and applies to healthcare services provided through September 30, 2026.
Important areas include remote patient monitoring, augmented intelligence services, hearing device services, and lower-extremity revascularization.
CMS publishes HCPCS Level II updates quarterly. Practices should review each applicable release and its effective date.
NCCI edits help identify incorrect code combinations and other coding issues that may affect claim payment. Reviewing applicable edits can help reduce avoidable denials and payment adjustments.
Not necessarily. Standard code sets provide a common reporting framework, but coverage, authorization, documentation, and reimbursement requirements can vary by payer and plan.
The transition into 2026 brings important coding developments that medical practices should address now. The CPT 2026 code set introduces new reporting options for emerging healthcare services, while FY 2026 ICD-10-CM and the October 2025 HCPCS and NCCI updates are already relevant to current billing operations.
Practices should review official code releases, update billing systems, educate their teams, and monitor payer requirements to maintain accurate coding and efficient claims processing.
Accurate coding is not simply a compliance responsibility—it is an important part of protecting practice revenue.
SaMeD RCM Solutions LLC — Your Revenue Cycle. Our Responsibility.
Disclaimer: This article is intended for general educational purposes only and does not constitute legal, coding, or reimbursement advice. Coding requirements may vary by payer, plan, and date of service. Always consult the applicable official coding files, guidelines, and payer policies before making billing or coding decisions.
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