The AMA released the CPT 2026 code set yesterday, September 11, 2025. It carries 418 changes: 288 new codes, 84 deletions and 46 revisions, all effective for dates of service on and after January 1, 2026. The AMA's own framing is that the changes track the shift of care into outpatient settings and the growth of remote and digital services. That is fair. The size is in line with recent years, and the deletions are where practices get hurt.
We have spent the day with the summary of changes. This article covers what stands out, how the CPT release meets the Medicare fee schedule final rule expected in early November, and the work to schedule between now and January. The ICD-10-CM update on October 1 is a separate project with its own plan; do not let the two blur together.
Key takeaways
- CPT 2026 carries 418 changes (288 new, 84 deleted, 46 revised), effective for dates of service on and after January 1, 2026. The deletions are where practices get hurt.
- Remote physiologic monitoring gains codes for 2 to 15 days of device data and for 10 to 20 minutes of monthly management, so the monthly time log now decides which code you bill.
- Whole code families are rebuilt for hearing device services, lower extremity revascularization and targeted prostate biopsy; every order set, charge ticket and authorization that references the old codes breaks on January 1.
- CPT says what the codes are; the fee schedule final rule expected around November 1 says what they pay. Map now, price in November.
- Check every commercial contract carve-out against the 84 deletions. A carve-out on a deleted code dies with it unless a successor-code clause exists.
What stands out
Remote monitoring
The remote physiologic monitoring family gains a code for device supply with 2 to 15 days of data in a 30-day period, closing a gap that has made the existing 16-day requirement a barrier for shorter monitoring episodes. It also gains a code for 10 to 20 minutes of monthly treatment management time, below the existing 20-minute threshold. For practices running hypertension or diabetes monitoring programs, this changes which patients are billable and how the monthly time is documented. It also means the monthly time log, which most programs keep loosely, becomes the deciding factor between two codes.
Hearing device services
The audiology codes 92590 to 92595 are replaced by a set of twelve codes describing hearing aid and hearing device services in more detail. Any practice with an audiologist needs the new codes in the charge master and the old ones retired.
Surgery
The surgery section carries a rebuilt code family for lower extremity revascularization, organized by vascular territory (iliac, femoral and popliteal, tibial and peroneal, inframalleolar) with the long-standing codes deleted, and a new family for targeted prostate biopsy that reflects MRI-fusion and other guided techniques. Vascular surgery, interventional radiology and urology practices should read their sections line by line. The AMA also highlighted new codes for services that involve augmented intelligence, which most practices will not bill in 2026 but which payers will use to decide how such services are covered. Where a code family is rebuilt, the old codes are usually deleted rather than revised, which means every order set, charge ticket and payer authorization referencing them breaks on January 1.
The rest
The remaining changes are spread across the code set: revisions to descriptors, Category III codes for new technology, and editorial changes to guidelines. The full list is in the AMA's summary of changes, and every practice should read the sections for its specialties rather than relying on a summary written by someone else, including us.
How CPT 2026 meets the fee schedule
CPT tells you what the codes are. Medicare's fee schedule final rule, expected around November 1, tells you what they pay, and the two arrive seven weeks apart. New codes receive RVUs in the final rule, and some are assigned carrier-priced or bundled status instead. The proposed rule in July, with its two conversion factors and its 2.5 percent efficiency adjustment on most procedures, already tells you the direction. The final rule adds the new codes and any changes CMS made after comments closed on September 12.
The practical consequence is that the charge master cannot be finished until November. What can be finished now is the mapping: which old codes go away, which new codes replace them, and which services the practice performs that will have a different code on January 1.
Contracts are where the money hides
Most commercial contracts pay a percentage of a Medicare fee schedule, but many carry carve-outs: specific codes with negotiated flat rates, often for the procedures the practice performs most. When a carved-out code is deleted, the carve-out dies with it unless the contract has a successor-code clause. Pull every contract, list the carved-out codes, and check them against the 84 deletions. Where a deleted code has a carve-out, write to the payer now asking how the successor code will be paid. A payer that has not been asked will default to its fee schedule, and the practice will not notice until March.
New codes with no contracted rate are a related problem. A payer's system will price a new code at whatever its fee schedule says, or pend it, or deny it as invalid until the payer's own update loads. Ask each of your top payers, in writing, when their systems will load CPT 2026, and expect at least one to say "the first quarter".
The plan from now to January
| When | What | Owner |
|---|---|---|
| September | Obtain the code set (book, data file or encoder update). Run twelve months of CPT usage against the deletions and revisions. Build the old-to-new mapping for your specialties. | Coding lead |
| October | Review contracts for carve-outs on deleted codes; write to payers. Ask top payers for their CPT 2026 load dates. Update EHR order sets, charge tickets and superbill templates in a draft version dated January 1. | Billing lead, practice manager |
| November | Read the fee schedule final rule. Load new RVUs and the practice's fee schedule. Update the charge master. Finish payer policy checks for codes that drive authorization. | Billing lead |
| December | Train providers on the codes in their favorites lists and coders on the full change list. Schedule the system update for the night of December 31. Set a daily rejection review for the first ten business days of January. | Coding lead |
| January | Watch rejections and denials by payer. Expect invalid code denials from payers that loaded late; hold and resubmit rather than write off. | Billing lead |
Mistakes from past Januarys
Using a new code in December because the book arrived. Assuming an authorization obtained in December for a code that is deleted January 1 will be honored for the successor code; call the payer and get it re-issued. Loading the Medicare fee schedule into the charge master and forgetting that the commercial contracts reference a different year's schedule. Training providers on the entire change list rather than on the dozen codes they actually use. Treating remote monitoring time as an afterthought and then discovering in February that the program has been billing the wrong code for a month.
Questions we hear
Does the efficiency adjustment apply to the new codes?
Under the proposed rule, the 2.5 percent adjustment applies to non-time-based services broadly, and new codes valued through the standard process would receive values that reflect it. The final rule will confirm the details. Model the new procedural codes with the adjustment included and treat anything better as upside.
Where is the best place to learn the changes?
The AMA's summary and the code set itself. Specialty societies publish good section-by-section guides in October and November. Our live RCM training runs an annual code update session in December that walks through the changes by specialty with charge master and contract examples, and the same material is used in the Revelrex EHR coding exercises.
Our contracts say nothing about successor codes. What do we ask the payer for?
Two things, in writing. First, a mapping: for each carved-out code that is deleted, which new code the payer will treat as its successor and at what rate. Most payers will say the successor pays at the standard fee schedule, which is your cue to negotiate rather than accept. Second, an amendment adding a successor-code clause so this conversation does not repeat every January: language saying that when a carved-out code is deleted, the negotiated rate applies to the code the AMA identifies as its replacement until the parties agree otherwise. Payers do not always agree, but the ones that refuse have told you something useful about the next renewal.
What to do this month
- Obtain the CPT 2026 code set or the encoder update and download the AMA summary of changes for each specialty the practice bills.
- Run twelve months of CPT usage against the 84 deletions and the 46 revisions, and write the old-to-new mapping for every affected code.
- List every carved-out code in every commercial contract and mark the ones that are deleted or revised.
- Send each top payer two written questions: when will CPT 2026 load in your system, and how will deleted carved-out codes be paid.
- Put the fee schedule final rule review, the December training session and the December 31 system update on the calendar with named owners.
