January 1, 2026, brings the American Medical Association’s largest CPT update in years. The code set changes total 418 items: 288 new codes, 84 deletions, and 46 revisions. Some of these will affect your specialties directly, while others change how you document, bill, and defend claims.

These updates go beyond simple code swaps. They reflect evolving care models and set higher expectations for clinical specificity and documentation integrity.

Below, we break down the most impactful changes, what they mean operationally, and the steps you should take now to ensure your teams, systems, and documentation are ready before the new year.

The Big Picture: Why The CPT Changes Matter

The 2026 update reflects three trends: rapid digital health adoption, explicit recognition of AI in clinical practice, and new technology-driven procedures. 

Together, these shifts signal a turning point in how the AMA views modern care delivery. AI-enabled tools are no longer treated as experimental add-ons but as integrated components of clinical decision-making, and emerging procedures, many of which are minimally invasive or software-assisted, are being codified at a faster rate than ever before.

The updates create new revenue opportunities. They also introduce new documentation requirements and short-term payer confusion. During the transition, practices may face denials, delays, and inconsistent coverage.

Managing this shift requires precise coding expertise, system updates, payer communication, and focused staff training. HOM provides this support through specialized medical coders, documentation guidance, EHR and billing configuration, payer outreach, and denial management.

With that context in mind, let’s break down the key CPT changes and what they mean for your operations:

1) Remote Monitoring Expansion

Remote monitoring codes have been expanded significantly. Five new codes now allow billing for monitoring periods of 2 to 15 days within a 30-day window. Previously, monitoring had to span at least 16 days. Two additional codes reduce the treatment-management time requirement to 10 minutes per calendar month, down from 20 minutes.

Shorter monitoring periods and lower time thresholds make many services billable for the first time. This is especially important for practices using wearables, sensors, and episodic monitoring models.

How to Prepare:

• Update documentation templates to capture device type, monitoring start and end dates, exact management minutes, and patient interaction details. 
• Train clinicians and support staff on time-stamping interactions and noting device data sources. Focus training on payer-ready documentation from day one through role-based sessions and real-world examples.
• Reconfigure EHR/billing logic to map monitoring flows to the new codes. Test claims in a sandbox environment to identify and fix issues before go-live.

2) AI-Assisted Clinical Services

CPT now includes codes that explicitly recognize AI-based clinical analysis. Examples include algorithm-driven coronary plaque assessment, cardiac dysfunction detection, burn wound classification, EEG waveform analysis, and brain connectomics.

AI work was often bundled into other services or not billed at all. These new codes allow reimbursement for AI-supported clinical analysis. But be sure to document everything as payment depends on clear, specific documentation.

Documentation Requirement: 

Claims must show three things:

• Identify the AI tool used, including name and version. 
• State the clinical output or question addressed. 
• Explain how the AI result informed the clinician’s decision. 

How to Prepare: 

• Build discrete documentation fields, train clinicians on payer-ready language, and conduct regular chart audits to ensure AI use is properly documented and defensible.
• Create a short checklist for clinicians to complete after AI-assisted decisions.
• Integrate this into existing workflows so it's fast, not a paperwork burden.

3) Audiology And Hearing Device Services

Twelve new audiology CPT codes now define specific services such as candidacy evaluations, device fittings, verification, troubleshooting, psychosocial support, and counseling. 

Each service uses time-based increments, such as an initial block of time followed by 15-minute units.

Audiology services now have clearer reimbursement pathways. They also require precise, time-based documentation to support billing.

How to Prepare:

• Rewrite audiology billing workflows, chargemasters, and fee schedules to include these new codes and increments. Update fee schedules and align charges to the new code logic before January 1 to avoid billing disruptions.
• Update pre-auth templates and intake forms to capture durations.
• Train the audiology staff to capture exact service types and time spent.

4) Radiology & Vascular Imaging

Leg revascularization coding shifts from anatomy-based reporting to a model based on procedural complexity and vascular territory. Several of the existing radiology codes have been deleted or revised.

Documentation must now describe the complexity of the procedure and identify the exact vascular territory treated. Relying on older anatomic descriptions is no longer sufficient for accurate coding and reimbursement.

How to Prepare:

• Map deleted radiology codes to new territory/complexity codes.
• Standardize intraoperative documentation templates to capture complexity markers and territory accessed.
• Pilot claims in a sandbox to detect misclassification and adjust workflows before wide release.

5) PLA Codes

Proprietary Lab Analysis codes account for about 27% of new CPT entries. New U-codes in the 0575U–0599U range replace older PLA codes. 

How to Prepare

• Contact payers to confirm which PLA codes they recognize.
• Create fallback plans for initial payer denials: alternative coding, prior authorization strategies, and appeal templates. Build these processes now rather than scrambling when denials arrive in Q1 2026.

Wrapping Up

The 2026 CPT update is more than a routine refresh. It changes how services are documented, coded, and reimbursed. From remote monitoring and AI-assisted care to audiology, imaging, and PLA codes, these updates will directly affect your revenue cycle. Waiting till the end will only increase the risk of denials, delays, and lost revenue.

The smartest approach is to act now. Start with a focused gap analysis. Update your documentation templates and billing systems. Train your clinicians and coders. Test claims early to catch issues before go-live.

HOM provides coding, documentation, system configuration, payer outreach, and denial-management support to guide that work. With the right preparation and expert support, you can turn these CPT changes into an opportunity for cleaner claims, faster payments, and stronger compliance in 2026.

Schedule a complimentary CPT gap analysis with HOM and get your teams ready.

FAQs:

1. Do the 2026 CPT changes affect all specialties equally?

No. While every practice will see some impact, specialties like cardiology, radiology, audiology, neurology, primary care, and telehealth-heavy services are most affected. Even if there are no major changes in your specialty, documentation standards and payer scrutiny will still increase, so every coding team should review the update.

2. How soon should practices start preparing for the 2026 CPT updates?

Ideally, 3–6 months in advance. This gives time for gap analysis, template redesign, EHR configuration, staff training, and test claims. Waiting until December leaves little room to fix issues before denials start impacting cash flow.

3. Do these CPT changes increase audit risk?

Yes. New codes often attract payer scrutiny, especially when tied to AI, time-based services, or emerging technology. Incomplete documentation or unclear medical necessity can trigger audits. Proactive chart reviews and coder education reduce this risk.

4. What happens if we continue using deleted CPT codes?

Claims will be rejected or denied. Deleted codes must be mapped to new replacements, or services may go unpaid. Updating charge masters and billing rules before January is essential to avoid disruptions.

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Key Takeaways:

• Big update: 418 CPT changes effective 1 Jan 2026 — 288 new codes, 84 deletions, 46 revisions.
• Why it matters: Changes reflect digital health, AI integration, and faster codification of new procedures.
• Risk & reward: New billing opportunities, but higher documentation requirements and short-term payer confusion.
• Remote monitoring: New codes for 2–15 day windows; lower time thresholds (10 min/month) make more services billable.
• AI-assisted care: New codes require clear documentation of the tool name/version, the clinical output, and how it guided decisions.
• Audiology: 12 new, time-based codes for candidacy, fittings, verification, counseling — update charge masters and intake forms.
• Radiology/vascular: Coding shifts to procedural complexity and vascular territory — document complexity and territory precisely.
• PLA/U-codes: Many proprietary lab codes moved to new U-code ranges; confirm payer recognition and plan for denials.
• Operational actions: Do a gap analysis, update templates, reconfigure EHR/billing, train staff, and test claims in a sandbox.

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