The 2026 CPT coding updates are here, and they’re bringing significant changes that will directly impact your practice’s revenue cycle. Whether you’re billing for primary care, specialty services, or diagnostic procedures, these updates require your immediate attention. Ignoring them or implementing them incorrectly will result in claim denials, payment delays, and frustrated staff members trying to figure out what went wrong.
CPT codes change every year, but the 2026 updates touch several high-volume service areas that many practices depend on. Remote patient monitoring, telemedicine, evaluation and management services, and interventional radiology all have meaningful changes coming. If your practice bills for any of these services, you need to know exactly what’s changing and how to adapt your documentation and billing processes.
Let’s break down the most important 2026 CPT changes, what they mean for your practice, and how to implement them correctly from day one.
Remote Patient Monitoring Gets a Makeover
Remote patient monitoring (RPM) codes have been incredibly popular since the pandemic accelerated telehealth adoption. These codes allow practices to bill for monitoring patients’ health data between office visits using devices like blood pressure monitors, glucose meters, and pulse oximeters. The 2026 updates refine how these services get documented and billed.
The time requirements for RPM services are getting more specific. Previously, practices could bill RPM codes with somewhat flexible time documentation. The 2026 guidelines tighten these requirements, demanding more precise tracking of the time spent reviewing patient data, communicating with patients about their readings, and adjusting treatment plans based on monitoring results.
99453
99543 covers the initial setup of remote monitoring equipment, now requires clearer documentation of patient education. You need to show that you educated the patient on how to use the device, what readings to watch for, and when to contact the practice with concerns. Simply handing a patient a blood pressure cuff and saying “use this at home” won’t cut it anymore.
99454
99454 for device supply and data collection over 16 days now specifies that the device must transmit data automatically to the practice. Manual entry by patients doesn’t qualify. This means practices using devices that require patients to log readings manually need to upgrade to devices with automatic transmission capabilities.
99457, 99458
The monitoring and interpretation codes (99457 and 99458) face stricter time documentation requirements. For 99457, you need at least 20 minutes of clinical staff time or physician/qualified healthcare professional time spent on monitoring activities during the calendar month. Add-on code 99458 requires an additional 20 minutes. You must document exactly what activities consumed that time, including reviewing transmitted data, identifying abnormal readings, communicating with patients, and modifying treatment plans.
Practices billing RPM codes should audit their current documentation to ensure it meets these new standards. Many practices have been billing RPM codes with loose documentation, and 2026 tightens the screws considerably. Your documentation should include timestamps showing when data was reviewed, notes describing what the data showed, records of patient communications, and any clinical decisions made based on monitoring data.
Telemedicine and Virtual Check-Ins Face New Rules
Telemedicine codes got a lot of use during the pandemic, and while some temporary flexibilities have expired, telehealth remains a permanent part of healthcare delivery. The 2026 updates clarify which services can be provided via telehealth and what documentation is required.
99441-99443
Audio-only visits, which were widely reimbursed during the public health emergency, now have permanent codes but with lower reimbursement rates than audio-visual visits. The new codes specifically for telephone evaluation and management services (99441–99443) are based on time: 5-10 minutes, 11-20 minutes, and 21-30 minutes respectively. These codes can only be billed when the telephone call results from a patient-initiated contact and when the call doesn’t result in a face-to-face visit within 24 hours or at the next available appointment.
G2012, G2252
Virtual check-in codes (G2012 and G2252) continue in 2026 but with more specific documentation requirements. These brief communication technology-based services require clear documentation that the communication was initiated by the patient (not the practice), lasted 5-10 minutes, and didn’t result from a visit within the previous seven days. Many practices were billing these codes too loosely, and auditors are now scrutinizing virtual check-in documentation carefully.
99421-99423
E-visits (online digital evaluation and management services) using codes 99421–99423 now require platforms that meet specific security standards. The 2026 guidelines specify that communication must occur through a HIPAA-compliant patient portal or secure messaging system. Regular email, text messages, or social media messages don’t qualify, even if they contain clinical information and result in clinical decision-making.
Telemedicine originating site requirements are becoming more standardized. For Medicare patients, the patient’s home is now a permanent originating site for most services, but documentation must show the patient has an established relationship with the provider. First-time patient visits via telemedicine now require specific attestations about why telehealth is appropriate for the initial evaluation.
Evaluation and Management Service Updates
E/M coding saw major changes in recent years, and 2026 brings additional refinements that affect how you select service levels and document encounters.
Time-based coding for office visits is getting clearer guidelines about what time counts. Total time on the date of the encounter includes pre-service work like reviewing records before the patient arrives, face-to-face or non-face-to-face time with the patient and family, and post-service work like documenting the encounter and coordinating care. However, the 2026 updates specify that time spent on separately billable procedures doesn’t count toward E/M time. If you’re doing a minor procedure during an office visit, you can’t count the procedure time toward your E/M level selection.
Medical decision-making (MDM) elements are getting additional clarification for 2026. The three elements of MDM (number and complexity of problems addressed, amount and complexity of data reviewed, and risk of complications) now have more specific examples of what qualifies for each level. For instance, reviewing external notes from another provider now clearly counts as data review, but simply documenting that you received the notes without discussing what was in them doesn’t count.
Split-shared visits, where both a physician and qualified healthcare professional see the patient on the same day, have new documentation requirements. The 2026 rules require clearer documentation of which provider performed what portion of the visit and which provider spent more than half the total encounter time with the patient (if using time-based selection) or performed the MDM (if using MDM-based selection).
Prolonged services codes for office visits are being modified. The threshold for adding prolonged service codes to office visits changes, and the time requirements for add-on codes are getting stricter. You now need 15 minutes or more beyond the maximum time for the highest-level office visit code (99215 or 99205) before you can bill the first unit of prolonged services. Each additional unit requires another full 15 minutes, not just 8-10 minutes as some practices thought.
Interventional Radiology Changes
Interventional radiology procedures are seeing significant coding changes in 2026, affecting how radiologists and interventionalists bill for their services.
Venous access codes are being restructured. The codes for central venous access procedures now have different options based on whether imaging guidance is used and whether the access is temporary or permanent. The bundling rules are changing too, affecting which imaging guidance codes can be billed separately versus which are now included in the primary procedure code.
Catheter placement codes for vascular access now distinguish more clearly between different types of catheters and different insertion sites. Previously, some codes covered multiple catheter types, but 2026 splits these into more specific codes based on catheter design and intended duration of use. This means more accurate coding but also means billing staff need to know exactly what type of catheter was placed.
Thrombectomy and thrombolysis codes are being revised to reflect current clinical practice. The codes now better distinguish between mechanical thrombectomy, pharmacologic thrombolysis, and combined approaches. Documentation must clearly specify which technique was used, which vessels were treated, and whether the procedure was successful in restoring blood flow.
Embolization procedures have new codes that distinguish between different embolization techniques and different anatomic sites. The 2026 codes separate out particle embolization, coil embolization, liquid embolic agent use, and other techniques that were previously lumped together. Accurate coding requires knowing exactly what embolic agent was used and what technique the interventionalist employed.
Imaging supervision and interpretation codes that accompany interventional procedures are being tightened. The 2026 guidelines specify that you can only bill separately for imaging S&I when you document that you personally supervised the imaging, interpreted the images, and generated a written report. Simply noting “fluoroscopy used” in the procedure note doesn’t support billing an S&I code.
Documentation Requirements Are Getting Stricter
Across the board, 2026 CPT guidelines emphasize documentation. Payers are auditing more aggressively, and your documentation must support the codes you’re billing. Generic templates and copy-forward notes won’t survive scrutiny.
For time-based coding, you need to document start and stop times or total time spent. Vague statements like “appropriate time spent” don’t support time-based code selection. Your note should say “35 minutes spent on evaluation and management of this patient” or include timestamps showing when the encounter began and ended.
For MDM-based coding, your documentation must address all three elements: problems addressed, data reviewed, and risk level. Each element should be explicitly documented. If you reviewed prior lab results, say so and describe what they showed. If you considered multiple diagnostic possibilities, document what they were and why you ruled them in or out. If you prescribed a medication with potential adverse effects, document why you chose that medication despite the risks.
For procedures, documentation must include the medical necessity for the procedure, the technique used, any complications encountered, and the outcome. Templated procedure notes that say “procedure performed without complications” without describing what actually happened won’t support your billing if audited.
Modifier Usage Changes
Several modifiers have new or revised definitions in 2026, and using modifiers incorrectly leads to claim denials or incorrect payments.
Modifier 25 for separately identifiable E/M services on the same day as a procedure is under intense scrutiny. Payers want to see clear documentation that the E/M service was significant and separately identifiable from the procedure’s usual pre- and post-service work. Your documentation should show that you evaluated and managed a problem unrelated to the procedure or that the patient’s condition required evaluation beyond what’s typically needed for the procedure.
Modifier 59 and its more specific X modifiers (XE, XS, XP, XU) now have clearer guidelines about when each should be used. CMS prefers the specific X modifiers over the generic 59 modifier because they provide more detail about why services should be paid separately. Using modifier 59 when a more specific X modifier applies may result in claim denials.
Telemedicine modifiers are being standardized. The various temporary telehealth modifiers from the pandemic are being replaced with more permanent modifiers that specify the type of telehealth service provided. Your billing system needs updating to use the correct 2026 modifiers for telehealth claims.
Specialty-Specific Changes Worth Noting
While we’ve covered the major changes affecting most practices, several specialties face unique updates in 2026.
- Cardiology has new codes for advanced cardiac imaging techniques and updates to stress testing codes that reflect current clinical protocols. Echocardiography codes are being restructured to better reflect different imaging approaches.
- Orthopedics sees changes to joint injection codes, arthroscopy procedure codes, and fracture care codes. The bundling rules for orthopedic procedures are being refined, affecting what can be billed separately on the same surgical encounter.
- Gastroenterology has updates to endoscopy codes, particularly for advanced endoscopic procedures like endoscopic mucosal resection and endoscopic submucosal dissection. Colonoscopy screening codes have refined definitions.
- Dermatology faces changes to destruction codes for skin lesions, with new codes distinguishing between different destruction methods and different lesion types. Mohs surgery codes have documentation requirement updates.
- Psychiatry gets expanded codes for crisis services and new codes for collaborative care management. Psychotherapy codes now have clearer time thresholds and add-on code requirements.
Implementation Strategy for Your Practice
Knowing about the changes is one thing. Implementing them correctly is another. Here’s how to prepare your practice for the 2026 updates.
- Start by identifying which code changes affect your specific specialty and services. Not every change matters to every practice. Focus your training and system updates on the codes you actually use regularly.
- Update your charge master and fee schedules with new codes and deleted codes. Remove old codes from your billing system to prevent staff from accidentally using them. Add new codes with appropriate descriptions and fees.
- Train your clinical and billing staff on the changes. Providers need to know about documentation requirement changes. Coders need to know about new codes and revised guidelines. Front desk staff should know about any new patient registration or insurance verification requirements related to telehealth services.
- Audit your documentation templates and revise them to meet new requirements. Remove outdated language, add prompts for required elements, and ensure templates support the coding guidance you’re following.
- Test your billing system’s ability to handle new codes and modifiers before you start billing them. Some practice management systems need updates or configuration changes to accommodate CPT updates.
- Establish monitoring processes to catch coding errors early. Review denial reports for patterns related to new codes. Audit a sample of claims using updated codes to ensure documentation supports billing.
How Medwave Keeps You Current
At Medwave, we specialize in billing, credentialing, and payer contracting for healthcare practices. Our billing team stays current on all CPT code changes, ensuring your claims are coded correctly from day one of any update.
We handle the implementation of annual CPT changes for our clients, updating charge masters, training staff on new requirements, and auditing documentation to ensure it supports the codes being billed. When 2026 codes go into effect, our team is ready with updated coding guidelines, documentation templates, and billing procedures.
Our expertise in multiple specialties means we know which changes affect your specific practice and how to apply them correctly. We monitor denial patterns related to code changes and quickly identify any issues that need correction.
Don’t let CPT code changes cost you money through denials or missed billing opportunities. Contact us today to learn how we can handle your billing challenges and keep you compliant with all coding updates.