Find Information on CPT®, HCPCS Code Updates
A new quarter and a new year are approaching, and that means code sets are being updated. On August 21, the Centers for Medicare & Medicaid Services (CMS) posted the fourth quarter 2025 update to the HCPCS Level II code set for reporting services, supplies, and equipment, which go into effect Oct. 1, 2025. Additionally, the 2026 AMA CPT® code updates have brought a plethora of new coding options for myriad healthcare situations, including an overhaul of codes for leg revascularization, an update of appendices, and recognition of the use of technology like augmented or assistive intelligence, types of artificial intelligence (AI). Here’s some of what you need to know about the 418 total changes in the 2026 CPT® code set, including 288 new codes, 84 deletions, and 46 revisions. You can find even more information regarding specific updates in RCI’s Pathology/Laboratory Coding and Technology & Innovation in Healthcare topic areas for this month. Look at a Whole New World of Leg Revascularization Reporting Coders who report lower extremity revascularization procedures have a lot of preparation to do before the 2026 code set goes into effect Jan. 1, 2026. The current codes have been deleted and there are 46 new codes that better reflect the advancements in technology and care delivery. According to the AMA, the code updates make reporting advanced therapies more accessible, which should benefit patients who experience persistent symptoms and haven’t responded to other medical treatments, as well as the providers who offer such mobility- and functional status-enhancing therapies. Find New Options for Hearing Device Services There are 12 new code options for reporting the provision of hearing devices. The AMA says that some of these codes reflect patient-centered care, including the assessment of visual, dexterity, and psychosocial factors. Other codes may bolster patients’ relationships with their hearing devices, including codes to report device performance and sound quality, as well as training and support for patients who may integrate a connection with their respective personal smartphones and hearing devices. Note Updated Appendices, Too Appendices have been updated to include new codes, like codes for reporting behavioral health services conducted via audio-video or audio-only technologies that are considered in correlation to services provided in person. The AMA CPT® Editorial Panel says that these inclusions may make behavioral health services more accessible to rural, underserved, and vulnerable populations and communities. Check Out Changes to HCPCS Level II Codes The HCPCS Level II update for the fourth quarter includes: 76 new codes, two codes with coverage and long descriptor changes, eight discontinued codes, 10 codes with long descriptor changes, two codes with payment changes, one reactivated code, and one code with a short descriptor change. There are seven new codes for reporting medical and surgical supplies, including codes to describe wound management, a breast pump replacement valve, fluorescein injections, and for radiopharmaceutical drug gallium ga-68 gozetotide. Six new C codes include options for reporting various supplies, insertion of a pleural-peritoneal shunt, and injections. Three new E codes include a combination wheeled walker with seat and a code for pneumatic appliances. There are 26 new J codes, including codes for injections and one for an oral drug, J0752 (Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)). As a result of this new code, J1961 was revised, with the descriptor changing from “Injection, lenacapavir, 1 mg” to “Injection, lenacapavir (only for use as hiv treatment), 1 mg” to describe SUNLENCA®. Code J0738 (Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)) was also created. There are seven new L codes, which may be used for reporting various prosthetics, including for the treatment of scoliosis; four new M codes for intravenous infusions; and 23 new Q codes, some of which can be used to report the use of membranes for allografts. Only two codes, E0765 (Fda approved nerve stimulator, for treatment of nausea and vomiting) and L6028 (Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at metacarpal level, including flexible or non-flexible interface, molded to patient model, including palm, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692), have coverage and long descriptor changes. Other codes with just long descriptor changes include C1739 (Tissue marker, uniquely detectable and identifiable with probe/sensor, any method (implantable), with delivery system). Also, A4453 (Rectal catheter with or without balloon, for use with any type transanal irrigation system, each) and A4459 (Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type) feature payment changes. Make sure you no longer use codes C9088, C9174, C9175, C9248, E0716, J2150, J2503, or S0074, because they’ve been discontinued. Codes C9174 and C9175 have been deleted and replaced with new codes J9011 (Injection, datopotamab deruxtecan-dlnk, 1 mg) and J0614 (Injection, treosulfan, 50 mg), respectively. Incorporate These Strategies Code set updates are a great time to check over your organization’s coding and billing workflows. Make sure everyone who uses these codes is on the same page about the updates and when they go into effect — don’t let anyone get confused about the Oct. 1, 2025, start date for some updates versus a Jan. 1, 2026, start date for others. Don’t forget to request access to the new coding books, either, so you can be sure that you have the updated descriptors and guidelines in hand while you code. Additionally, you should make sure your electronic health record (EHR) and any other code-using software updates so the information therein is accurate. It’s especially important to be aware of which claims are going out right around the effective date, so you can be aware of the “changeover” period and make sure any affected claims are still coded and billed accurately. Such practices will help your organization maintain compliance and prevent any delays in payment as everyone incorporates and adapts to the coding updates. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
