Every January we see the same denial pattern in the second week: a run of claims rejected for an invalid procedure code, usually with CO-181 (procedure code was invalid on the date of service) or CO-4 (procedure code inconsistent with the modifier). The codes were valid on December 31. The charge master still has them. Nobody retired them.
The CPT 2026 code set, released by the AMA in September 2025 and effective January 1, 2026, contains 418 editorial changes: 288 new codes, 84 deletions and 46 revisions. That is a normal-sized update by count, but the changes are concentrated in a few areas where the old codes were deleted outright rather than revised. If you bill remote monitoring, vascular procedures, audiology or anything touched by AI-assisted analysis, this update needs hands-on work rather than a vendor file load.
Key takeaways
- Work the 84 deleted codes first. A deleted code in an EHR order set or a saved claim template produces a CO-181 rejection on every claim until someone finds it.
- Remote physiologic monitoring gained two codes, 99445 for 2 to 15 days of device data and 99470 for 10 to 19 minutes of management, so patients who used to fall below the thresholds are now billable.
- Most of the new augmented intelligence codes are Category III tracking codes, and a code existing is not the same as a code paying.
- The lower extremity revascularization family was rebuilt, and restructured families produce more coding errors in the first quarter than any other kind of change.
- Medicare still does not pay the 98000-series telemedicine E/M codes; keep reporting standard office visit codes with the place of service and modifier your MAC requires.
Start with the deletions, not the additions
New codes only cost you money if you fail to use them. Deleted codes cost you money on every claim until you notice. Pull the AMA's deleted code list and run it against every place a CPT code lives in your practice: the charge master, the superbill or charge capture templates in the EHR, order sets, the fee schedules loaded for each payer, and any saved claim templates your billers use for recurring services. In most practices the EHR order set is the one everyone forgets, and it keeps generating the old code long after the charge master was fixed.
For each deleted code, record the replacement code or codes and whether the mapping is one-to-one. Where one old code became two or three new ones, the coder needs the documentation to pick the right one; a blind crosswalk in the billing system will pick wrong.
Remote patient monitoring: shorter durations finally have codes
The change that affects the most practices is in remote physiologic monitoring. Since 2019, device supply code 99454 required at least 16 days of readings in a 30-day period, and treatment management code 99457 required at least 20 minutes. Patients who transmitted for 10 days, or whose management took 12 minutes, produced no billable service at all. CPT 2026 adds 99445 for device supply with 2 to 15 days of data in a 30-day period, and 99470 for the first 10 to 20 minutes of treatment management in a calendar month. The 16-day and 20-minute codes remain for the higher thresholds.
| Service | Code | Threshold |
|---|---|---|
| Device supply and transmission | 99445 | 2 to 15 days of data in 30 days (new) |
| Device supply and transmission | 99454 | 16 or more days of data in 30 days |
| Treatment management | 99470 | First 10 to 20 minutes in a calendar month (new) |
| Treatment management | 99457 | First 20 minutes in a calendar month |
| Treatment management | 99458 | Each additional 20 minutes |
The operational point: your RPM platform's month-end report now needs to bucket patients by days of data (2 to 15 versus 16 plus) and by management minutes (10 to 19 versus 20 plus). Ask your vendor whether the report has changed. Several have not. Also confirm that your payers have loaded the new codes; the fee schedule search on the CMS site shows whether Medicare priced them, and commercial payers usually lag by a quarter.
Here is what the change looks like on a real panel. Suppose a cardiology practice has 120 patients on blood pressure monitoring. In a typical month under the old rules, about 85 of them transmitted 16 or more days and 35 fell short, and those 35 produced no device supply charge at all. In January, the 35 short-transmission patients who had at least 2 days of data become 99445 claims. On the management side, if 20 patients had between 10 and 19 minutes of clinical staff time, those 20 months become 99470 instead of nothing. The practice did not change the care it delivered; it stopped giving away a portion of it. The risk runs the other way too: a report that still rounds every patient up to 99454 and 99457 is now overbilling a third of the panel, and that is the kind of pattern that shows up in a payer's data analytics within a quarter.
Augmented intelligence codes
The 2026 set continues to build out codes for services where software analyzes data and a clinician acts on the result. Most of these sit in Category III (the T codes), which means they are tracking codes: many payers do not pay them, and Medicare pricing is carrier-determined. Before a practice buys an AI-assisted diagnostic tool on the promise of a new CPT code, we tell them to check three things: whether the code is Category I or III, whether their MAC has a payment amount, and whether their top commercial payers have a medical policy for it. A code existing is not the same as a code paying.
Hearing devices and lower extremity revascularization
Audiology and ENT practices have a new family of codes for services involving hearing devices, including evaluation, fitting and programming. If you have been reporting these with unlisted codes or older device codes, the new codes are more specific and should replace them. Documentation needs to support the device type and the service performed.
Vascular surgery and interventional radiology got the largest structural change. The lower extremity revascularization codes were rebuilt to describe the vessels treated and the interventions performed differently from the previous family. Practices in those specialties should have their coders work through the new section of the manual with the AMA's guidance rather than rely on a vendor crosswalk. In our experience, a restructured family like this produces the most coding errors in the first quarter of any update.
Evaluation and management guidance
The E/M guidelines received clarifications rather than new codes. They are worth reading because payers cite guideline language in audits. Nothing here changes the level selection method (medical decision making or total time on the date of the encounter), but wording around what counts toward time and how to handle shared visits was tightened. Give your providers a one-page summary rather than the full guideline text.
One thing that did not change: Medicare still does not pay the CPT telemedicine E/M codes in the 98000 series that the AMA introduced in 2025. For Medicare telehealth visits, continue reporting the standard office visit codes with the place of service and modifier your MAC instructs. Some commercial payers do accept the 98000 codes, so check each payer's policy rather than applying one rule.
Practices that want their coders walked through the changes can find our live sessions on the training page; the live sessions walk through each year's code update in detail. If the coding is outsourced to us, the crosswalk has already been done, and the billing team will flag any deleted codes coming from the EHR back to the practice.
Questions we hear
Can we bill 99445 and 99454 in the same month?
No. They describe the same service at different thresholds. Pick the one the days of data support. The same applies to 99470 and 99457 for management time.
We had a claim for a December service deny with CO-181 in January. Is that the update?
Probably not. A December date of service should be adjudicated against the 2025 code set. Check whether the claim carried a 2026 code that did not exist in December (a new code applied too early) or whether the date of service was keyed wrong. Both happen in the first week of the year.
Our EHR vendor says the code update is applied automatically. Is there anything left to do?
The vendor updates the code table, which is the list of valid codes. It does not usually update the places where your practice chose a code: order sets, favorites lists, superbill templates and saved claims. In our experience the vendor load and the practice clean-up are two different jobs, and the second one is the one that prevents the rejections. Ask the vendor specifically whether it retires deleted codes from templates or only from the master table.
What to do this week
- Run the deleted code list against the charge master, EHR order sets, superbill templates and saved claim templates.
- Load the new codes and assign a default fee; do not leave them at zero or claims will drop to a hold queue.
- Confirm Medicare pricing for each new code your practice will bill, and note which are carrier-priced.
- Ask your RPM vendor for the updated month-end report with the 2 to 15 day and 10 to 19 minute buckets.
- Run a test batch of January claims through the scrubber and read every edit before the real batch goes.
- Watch the clearinghouse rejection report daily through the end of January for invalid code rejections.
