2026 CPT Code Updates: What Specialty Practices Need to Know

Published April 4, 2026 · 10 min read · By RCMAXIS Coding Team

The American Medical Association released the 2026 CPT code set with 418 changes: 288 new codes, 84 deletions, and 46 revisions. For specialty practices, several changes have significant reimbursement implications. Here is what our certified coders at RCMAXIS are tracking for our clients.

Cardiology: Key Changes

Cardiology practices see the most impactful changes in 2026, affecting how specialty clinics bill for common diagnostic procedures.

Cardiac Catheterization Revisions

CPT codes 93451-93462 have been revised to better distinguish between right heart, left heart, and combined catheterization procedures. The revised descriptors require documentation of specific hemodynamic measurements obtained during each catheterization approach. Practices must update charge capture templates to match new documentation requirements.

Remote Cardiac Monitoring

Three new codes have been introduced for AI-assisted remote cardiac monitoring, reflecting the growing adoption of wearable cardiac devices. These codes require documentation of the AI algorithm used, physician review time, and clinical decision-making based on AI-flagged events.

Echocardiography Updates

Stress echocardiography codes have been restructured to separate the imaging component from the stress testing component, allowing more accurate billing when different providers perform each portion.

Orthopedics: Key Changes

Orthopedic coding updates primarily affect surgical procedure bundles and post-operative care documentation, directly impacting practices that bill for complex procedures. Our orthopedic case study demonstrates how proper coding significantly impacts collections.

Arthroscopy Code Restructuring

Knee arthroscopy codes (29880-29887) have been revised with clearer bundling rules for combined procedures. The revision eliminates ambiguity around modifier 59 usage for distinct arthroscopic procedures performed through the same portal during a single session.

Spinal Fusion Add-On Codes

New add-on codes have been created for interbody fusion techniques using emerging biomaterials, with specific documentation requirements for graft type, cage dimensions, and approach.

Fracture Care Global Period Changes

CMS has adjusted global period RVUs for select fracture care codes to better reflect current practice patterns, including follow-up visits conducted via telehealth within the global period.

Behavioral Health: Key Changes

The 2026 updates bring significant changes for mental health and behavioral health billing, particularly around integrated care models and digital therapeutics.

Collaborative Care Model Expansion

Codes 99492-99494 (Psychiatric Collaborative Care Management) have been expanded with new add-on codes for extended team conferences and medication management components. Documentation now requires structured outcome measure reporting at defined intervals.

Digital Therapeutics Codes

Four new codes cover prescription digital therapeutics (PDTs) for substance use disorders, insomnia, and chronic pain. These codes require documentation of the FDA-cleared PDT product prescribed, patient engagement metrics, and clinical outcome tracking.

Telehealth Modifier Updates

Modifier 95 (synchronous telehealth) requirements have been updated to include documentation of the technology platform used, confirmation of patient identity verification, and notation of any technical difficulties affecting the session.

Cross-Specialty Impact: E/M Changes

While the 2021 E/M overhaul stabilized office visit coding, the 2026 update introduces refinements affecting all specialties:

• Time-based documentation: Clarified that total time includes pre-visit chart review performed on the same calendar date as the encounter
• Complexity add-on (G2211): Permanent adoption after pilot period, now billable by all providers (not just primary care) for ongoing care relationships
• Split/shared visits: Final rules for facility-based E/M split between physicians and NPPs, requiring clear documentation of substantive portions

What Your Practice Should Do Now

1. Audit current workflows against the new code descriptors for your top 20 procedures by volume
2. Update charge capture templates in your EHR to reflect new documentation requirements. See our EHR integration guide for best practices.
3. Train providers on revised documentation requirements before the effective date
4. Update fee schedules with new RVUs and expected reimbursement rates
5. Monitor denial trends for 90 days post-implementation through your analytics dashboard

At RCMAXIS, our coding team proactively updates all client workflows 30 days ahead of CPT effective dates. Need help navigating these changes? Schedule a coding review.