New CPT Codes and CMS 2026 Payment Changes for Healthcare Providers

The American Medical Association (AMA) has released the CPT 2026 code set, introducing new, revised, and deleted codes that will affect how services are documented and billed. Alongside this, the Centers for Medicare & Medicaid Services (CMS) has proposed changes to the Physician Fee Schedule (PFS) that outline how those services may be reimbursed.

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Together, these changes carry important implications for practices, revenue cycle teams, and patients. Preparing now will help minimize payment disruptions and position organizations to take advantage of new opportunities in 2026.

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Key CPT 2026 Changes from the AMA

The 2026 CPT code set introduces 288 new codes, 84 deletions, and 46 revisions. Many of these revisions highlight the growing role of digital health, AI, and outpatient care.

• Remote Patient Monitoring (RPM): New codes for 2–15 days of monitoring within a 30-day cycle, plus a reduced time threshold for treatment management (10 minutes per month).
• AI-Augmented Diagnostics: Fresh codes for algorithmic and AI-assisted imaging, including coronary plaque and perivascular fat assessment.
• Leg Revascularization: Older codes deleted and replaced with new descriptors reflecting current procedural techniques.
• Hearing Device Support: Twelve new codes for training, counseling, and device-related support.

The AMA also highlighted two important trends in the 2026 code set:

• Proprietary laboratory analyses account for the largest share of new codes, making up 27 percent of the additions.
• Category III codes for emerging services and technologies represent another significant portion, signaling the AMA’s focus on capturing innovation.

These changes will require billing system updates, documentation adjustments, and coder education well before January 1, 2026.

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CMS’ Proposed Rule for 2026

On the reimbursement side, CMS’ proposals will influence how these codes translate into payment. The rule includes both positive updates and cost-containment measures.

Key elements include:

• Conversion Factor Updates: A 2.50 percent statutory increase plus a 0.55 percent RVU adjustment. Qualifying APM participants would see a slightly higher increase than non-participants.
• Efficiency Adjustment: A 2.5 percent cut to work RVUs for non–time-based services, tied to assumptions that technology has shortened required physician effort.
• Specialty-Specific Valuations: New values for cardiology and revascularization procedures, along with adjustments to GPCIs and malpractice RVUs.
• OPPS and ASC Adjustments: A new HCPCS add-on code for Tc-99m radiopharmaceuticals, plus expanded price transparency rules for hospitals.

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Specialty Impacts

The effects of these changes will vary depending on the type of practice.

• Primary Care and Internal Medicine: Opportunities in new RPM codes, but possible revenue reductions from efficiency adjustments.
• Cardiology and Radiology: Expanded reimbursement for AI diagnostic codes and revascularization updates, balanced by more complex documentation.
• Behavioral Health and Digital Health: Shorter-duration RPM codes support virtual monitoring, but practices must be ready to meet stricter reporting standards.

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Revenue Cycle Considerations

Operationally, the risks are clear. If billing systems or documentation processes aren’t updated, denials will follow. Revenue cycle leaders should focus on:

• Reviewing deletions and revisions to avoid invalid code submissions
• Training staff to meet documentation requirements for RPM and AI codes
• Confirming payer adoption timelines to prevent reimbursement delays
• Modeling revenue scenarios to account for both gains and reductions

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What Practices Should Do Now

Preparing for these changes doesn’t need to be overwhelming. A few focused steps now can make a big difference heading into 2026:

1. Audit Code Usage: Review current claims for codes that will be deleted or revised, and identify services that fit new CPT options.
   
   
2. Update Systems and Train Staff: Adjust EMRs, templates, and documentation processes, and prepare coders for new descriptors.
   
   
3. Engage Payers: Confirm adoption plans for CPT 2026 and request updated fee schedules where possible.
   
   
4. Run Financial Models: Project both potential new revenue streams and cuts from efficiency adjustments.
   
   
5. Stay Informed: Continue following CMS and AMA updates through the end of the year.

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The bottom line

The CPT 2026 code set introduces important changes that expand how services can be documented and billed, from AI-assisted diagnostics to remote patient monitoring. Alongside these updates, CMS’ proposed Physician Fee Schedule (PFS) will shape how those services are valued and reimbursed.

For practices, the combination of coding updates and payment proposals creates both opportunities and risks. By auditing current processes, training staff, engaging payers, and running financial models now, providers can reduce disruptions and be ready to benefit from the changes when they take effect in 2026.