The 2026 CPT and HCPCS Level II updates introduce new codes and restructuring that directly impact medical billing, coding accuracy, and healthcare compliance.
Healthcare delivery is increasingly digital, data-driven, and remote. These updates codify technology adoption, automation, and new care settings while shaping how providers, billers, auditors, and revenue-cycle teams document and submit claims. Using outdated codes can lead to claim denials, underpayment, compliance risks, and audit exposure.
Key features driving the CPT 2026 updates include:
- Artificial Intelligence (AI)–enabled services
- Remote patient and therapeutic monitoring
- Full audiology and hearing device overhaul
- Lower Extremity Revascularization (LER) restructuring
- Behavioral health and care integration updates
Understanding these updates allows healthcare organizations to prepare systems, train staff, and minimize errors when the new codes take effect on January 1, 2026, as mandated by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).
Overview of 2026 CPT & HCPCS Updates
The 2026 CPT and HCPCS code updates introduce 288 new codes, 84 deletions, and 46 revisions, impacting multiple specialties and healthcare billing workflows.
Early awareness of these updates allows healthcare organizations to prepare systems, streamline workflows, and train staff before implementation. Proper preparation ensures compliance, accurate billing, and minimized claim errors.
| Aspect | CPT 2026 Updates | HCPCS Level II 2026 Updates |
| What’s New | AI diagnostics, short-term RPM, time-based audiology | New Behavioral Health G-codes, specific catheter codes |
| What’s Removed | Old LER codes, legacy hearing aid codes (92590-92595) | Generic catheter supply codes |
| What’s Changed | Bundled procedure rules, supervision requirements | Telehealth supervision policy, skin substitute payment |
| Who’s Most Affected | Cardiology, Radiology, Audiology/ENT, Primary Care | Behavioral health, suppliers, rural/outpatient clinics |
Together, CPT code updates and HCPCS modifiers should be applied together to support clean claim submission and accurate reimbursement.
CPT Code Updates for 2026
The 2026 CPT updates introduce new, revised, and deleted codes across multiple specialties, impacting billing, coding accuracy, and compliance.
Healthcare organizations must understand these changes to update workflows, train staff, and ensure accurate claim submission before the codes take effect.
1. Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM)
The 2026 CPT update introduces new RPM and RTM codes that formally support this model, and Virtual care is now a permanent component of healthcare delivery. These updates enable billing for shorter monitoring periods (2-15 days) and lower the management threshold to 10 minutes, addressing a critical gap for episodic and post-operative care that did not fit previous requirements.
Key Implications:
- Billing Requirements: Despite the flexible timeframes, strict documentation for device use, data transmission, clinical review, and interactive communication remains essential to avoid claim denials.
- Impact: These changes solidify the financial viability of telehealth, allowing practices to receive accurate reimbursement for hybrid and short-term virtual care models that reflect actual clinical workflows.
2. Artificial Intelligence (AI)- Enhanced Services
The year 2026 marks a turning point with the first CPT codes created just for AI-assisted services. This move basically formalizes AI as a diagnostic tool. You’ll find specific codes for analyzing heart risk, classifying burns, and running advanced imaging analytics.
- Critical Distinction: The AMA specifies that only “assistive AI”, where the clinician uses AI as a decision-support tool but retains final authority qualifies for CPT reporting. Autonomous AI systems do not.
Requirements & Impact: - Documentation: Clinicians must document the specific AI tool used, its clinical purpose, and how the output informed the clinical decision.
- Specialties Affected: Radiology, cardiology, dermatology, and primary care will be most impacted, reflecting a regulatory commitment to integrating AI responsibly into patient care.
3. Complete Audiology/Hearing Device Code Overhaul
Throughout the history of CPT, audiology has gone through extensive restructuring. In the CPT 2026 update, legacy hearing aid codes 92590-92595 are deleted. In replacement, we have a more modern and time-based framework.
12 time-based CPT codes are introduced with this new structure. These codes are segmented by service type, not bundled device delivery.
Segments include:
- Candidacy evaluation
- Device selection and counseling
- Real-ear fitting and verification
- Follow-up adjustments and optimization
Why It Matters: We’re finally moving from “buying a device” to “paying for a service.” This shift is all about transparency and value-based care. It does mean ENT and audiology practices have some homework to do, you’ll need to overhaul your charge capture and documentation to keep up.
4. Lower Extremity Revascularization (LER) – Total Rebuild
One of the most significant procedural coding changes in years, the 2026 update provides a definitive solution: 46 new territory-based LER codes replace the entire old system. This total rebuild is designed to end the guesswork and eliminate the unintentional overcoding that plagued the previous framework.
New Classification Structure:
- By Territory: Iliac, Femoral/Popliteal, Tibial/Peroneal, Inframalleolar.
- By Complexity: Distinguishes simple stenosis from complex occlusions.
- Documentation Imperative: Operative reports must clearly describe treated vessels, lesion complexity, and intervention approach to support correct, compliant code selection.
5. Pathology & Laboratory Changes
Expansion continues in genomic and molecular testing with the introduction of new Proprietary Laboratory Analysis (PLA) codes.
Preparation Steps for Labs:
- Verify payer coverage and pricing for new PLA codes, which often have unique reimbursement rules.
- Review test menus and update documentation and billing workflows accordingly.
6. Cardiology & Vascular Updates
There are two key updates for cardiology and vascular coding this year. First, the PCI codes are getting more detailed. Second, there are new Category III codes for tracking emerging tech, including those wireless IVC monitors.
Understanding Category III
These temporary codes allow for data collection on new services and are distinct from permanent Category I codes. Providers must understand when their use is appropriate, with an expectation for future conversion as clinical evidence matures.
7. Oncology, Immunization, and Other Specialty Updates
Several specialties are affected with the CPT 2026 update as well. These new codes support chemotherapy scale cooling services which reflect patient-centered oncology care.
- Oncology: New codes support services like chemotherapy scalp cooling, reflecting patient-centered care advancements.
- Immunization: New time-based counseling codes allow for more accurate reporting of vaccine education and shared decision-making.
- Other: Widespread minor revisions refine documentation requirements and clarify reporting rules across specialties.
HCPCS Level II Code Updates for 2026
The 2026 HCPCS Level II updates introduce new, revised, and deleted codes for medical supplies, durable medical equipment (DME), and Medicare-specific services.
These updates complement CPT updates by covering non-physician services, ensuring accurate billing, compliance with Centers for Medicare & Medicaid Services (CMS) rules, and proper reimbursement across healthcare settings.
1. New Behavioral Health Integration (BHI) G-Codes
New Behavioral Health Integration G-codes G0568-G0570 have been added to HCPCS Level II Code Updates 2026. These are add-on services that facilitate support of coordinated mental health care.
These codes are used in conjunction with the Collaborative Care Model and enhance reimbursement of care coordination, psychiatric consultation, and continuous communication with a patient.
These changes promote mental health reimbursement development and lead to better mental health access and sustainability.
2. Updated Catheter A-Codes (A4295–A4297)
The introduction of new hydrophilic intermittent catheter grouping can be expected as CMS updates catheter coding. In favor of more specific classifications, generic catheter coding is phased out.
Pricing accuracy is then improved with this change and supply categories can be made more aligned. Providers and suppliers must review and update their inventory mapping and billing systems accordingly.
3. Telehealth Policy Changes
As telehealth supervision rules evolve, the 2026 HCPCS modifications provide clearer, permanent guidance. The 2026 HCPS modifications can help understand when it is permanently permissible to utilize virtual supervision.
Although certain situations demand the use of video surveillance, there are still cases that need physical presence. These increased flexibilities are most helpful to the rural providers and the outpatient clinics.
These differences must be understood comprehensively to prevent compliance problems.
4. Skin Substitutes Policy Changes
Reimbursement and policy refinements can also be seen with skin substitute products with the 2026 HCPCS updates. Skin Substitutes Policy Changes include a new single payment rate for non-facility settings. An example would be for physician offices and outpatient clinics. With these changes, we can expect simplified billing, reduced variability, and a more predictable reimbursement.
CMS clarifies when these products qualify as incident-to supplies as well. To meet these requirements, services must meet the following:
- Furnished under direct supervision of a qualified healthcare professional
- Provided as a part of an established plan of care
- Medically necessary for wound management and healing.
To avoid denials and support medical necessity, detailed documentation is required. Payer policies must be reviewed carefully by practices to reduce risk of denials and payment delays.
Comparison Snapshot: CPT vs HCPCS Updates in 2026
CPT and HCPCS serve distinct but complementary roles in the billing ecosystem. CPT (Current Procedural Terminology) codes describe physician services, procedures, and clinical work, while HCPCS (Healthcare Common Procedure Coding System) Level II codes identify supplies, durable medical equipment (DME), and Medicare-specific services not covered by CPT.
The 2026 updates for both code sets must be implemented in tandem to ensure clean claims and accurate reimbursement. Both officially take effect on January 1, 2026.
| Comparison Area | CPT Updates (2026) | HCPCS Level II Updates (2026) |
| Primary Purpose | Describes physician/clinical procedures and professional services. | Identifies supplies, DME, and Medicare-specific billing requirements. |
| Key Areas Affected | AI services, RPM/RTM, audiology, LER procedures, cardiology, behavioral health. | Behavioral health integration, telehealth supervision, catheters, skin substitutes. |
| Effectivity Date | January 1, 2026 | January 1, 2026 |
| Volume of Changes | 288 new codes, 84 deleted, 46 revised. | Multiple new, revised, and deleted codes and modifiers affecting coverage. |
Adopting both updated code sets jointly is non-negotiable for compliant billing and proper reimbursement starting January 1, 2026.
How These 2026 Changes Affect Providers, Coders & Billers
The 2026 CPT and HCPCS updates affect providers, coders, and billers by requiring updated documentation practices, revised workflows, and targeted staff training to ensure accurate billing and compliance.
Healthcare organizations must adjust systems, workflows, and staff knowledge to accommodate new codes, modifiers, and structural changes. The primary impacts include:
Key impacts of the 2026 updates include:
System and workflow updates
Electronic Health Record (EHR) and billing systems must be updated to process new CPT/HCPCS codes, modifiers, and reporting requirements.
Coverage verification with payers
Providers and billing teams should confirm insurance coverage in advance for AI-enabled services, Remote Patient Monitoring (RPM), and new behavioral health codes.
Training and staff readiness
High-impact areas such as Lower Extremity Revascularization (LER), audiology, and AI services require targeted training due to significant structural changes in documentation and billing rules.
Compliance and audit preparedness
Accurate adaptation ensures claims are processed efficiently and reduces the risk of denials or audit exposure, aligning with CMS and AMA guidelines.
Best Practices to Prepare for CPT & HCPCS 2026 Updates
For practices to be able to adapt to the new updates, proactive steps should be taken before January 2026. Best practices to prepare for CPT & HCPCS 2026 updates include:
- Updating internal billing manuals
- Staff training on new codes (especially LER & hearing aid overhaul)
- Perform internal audits before January 2026
- Update EHR, clearinghouse, and payer settings
- Communicate with payers about coverage updates
- Validate RVUs and reimbursement changes
- Update charge capture workflows.
Taking proactive steps reduces disruption and protects revenue.
How to Avoid Claim Denials Related to 2026 Coding Changes
Claim denials related to 2026 CPT and HCPCS updates are primarily caused by outdated codes, insufficient documentation, and incorrect modifier usage.
Preventing these denials requires a structured approach and collaboration among providers, coders, and billers. Key prevention strategies include:
Primary strategies to reduce claim denials:
- Confirm documentation for new codes
Ensure all required clinical documentation elements are captured for high-impact codes, including AI-enabled services, Remote Patient Monitoring (RPM), LER, and audiology updates. - Align coding, billing, and clinical teams
Maintain continuous communication between coders, billers, and clinicians to verify accurate coding, modifier application, and claim preparation. - Monitor payer-specific HCPCS and CPT policies
Track updates in coverage determinations that affect claim approval and reimbursement to prevent denial due to policy misalignment. - Implement structured billing and coding checklists
Standardized workflows and checklists reduce human error, ensure compliance, and minimize claim rejection risk.
By following these steps, healthcare organizations can reduce denials, optimize reimbursement, and maintain compliance with AMA and CMS guidelines.
Conclusion: Staying Ahead of CPT & HCPCS Changes in 2026
The big idea behind the 2026 updates? To bring care into the modern era. They’re making space for new technology, getting different providers on the same page, and putting better quality and value front and center.
Adopting these changes supports compliance, ensures accuracy for reimbursements, and reduces the risk in operations. AI, RPM, and telehealth will continue shaping the future and succeeding code sets.
Updates will start taking into effect on January 1, 2026. Preparing early will enable organizations to start the year with confidence and control.
Frequently Asked Questions (FAQs)
What changed in the 2026 HCPCS updates?
First, new G-codes are coming for behavioral health integration. Second, catheter supply coding gets an update. Third, telehealth supervision rules are refined, and a simple flat rate is set for skin substitutes in clinics.
How should clinics prepare for the 2026 CPT and HCPCS code changes?
Clinics should prioritize three actions before January: update EHR and billing software with the new code sets, train staff on high-impact changes like the LER and audiology overhauls, and verify payer coverage for new services. Proactive preparation is essential to avoid claim denials and revenue disruption.
Why were the Lower Extremity Revascularization (LER) codes completely replaced?
The old LER system was too vague, leading to inaccurate billing and compliance risk. The 2026 overhaul introduces 46 precise, territory-based codes that improve specificity and align coding with the actual complexity of the procedure performed.
What new CPT codes are available for remote patient monitoring in 2026?
The 2026 update introduces new RPM/RTM codes that support much shorter monitoring periods (as brief as 2-15 days). This change allows for accurate billing of episodic and acute care, not just long-term chronic condition management.
Did AMA add new AI-related CPT codes for 2026?
Yes. For the first time, the CPT set includes specific codes for AI-assisted diagnostic services in areas like cardiac and imaging analysis. These codes are strictly for assistive AI where the clinician retains decision-making authority.
How will the 2026 coding updates affect claim denials?
Denial risk will jump for unprepared practices. They’ll likely use old codes or have incomplete documentation for the new rules. To prevent this, you need to take action: update your systems, train your team, and check with payers ahead of time.
What are the biggest CPT code changes for 2026?
The most significant changes are the introduction of first-ever AI service codes, the complete replacement of all Lower Extremity Revascularization codes, and a total overhaul of audiology coding to a time-based model.
When do the 2026 CPT and HCPCS updates go into effect?
All updates officially take effect on January 1, 2026. Services provided on or after this date must use the new 2026 code sets.
How many new CPT codes were added for 2026?
A total of 288 new CPT codes were added for 2026. Additionally, 84 codes were deleted and 46 were revised, making this a substantial update.
What specialties are most impacted by the 2026 CPT updates?
Cardiology, vascular surgery, audiology, and radiology are most impacted due to the LER rebuild, audiology overhaul, and new AI codes. Behavioral health and primary care are also heavily affected by new integration and monitoring codes.
