12/26/2025
🚨 CPT 2026: CODES DELETED JAN 1ST! 🚨
Major Billing Changes You Can’t Ignore
The AMA’s 2026 CPT® code set introduces:
✅ 288 New Codes
❌ 84 Deleted Codes
📅 Effective: January 1, 2026
Immediate action is required to stay compliant and protect revenue.
SLIDE 1: MAJOR SURGICAL OVERHAUL
Lower Extremity Revascularization (LER)
🚫 STOP Billing (Deleted Codes):
Entire LER code range 37220–37500 is eliminated
✅ START Billing (New Code Strategy):
46 New Codes (37254–37299)
Coding now depends on:
Specific vascular territory (Iliac, Femoral/Popliteal, etc.)
Lesion complexity (Straightforward vs. Occlusion)
⚠️ Impact:
Immediate RCM Risk:
All peripheral intervention billing workflows must be updated to avoid widespread denials starting Jan 1, 2026.
SLIDE 2: PROSTATE BIOPSY BILLING SHIFT
🚫 STOP Billing (Deleted Codes):
55700 – General needle/punch biopsy
55705 – Non-image guided incisional biopsy
✅ START Billing (New Code Strategy):
New code series 55707–55714
Billing is now based on technology used, including:
Ultrasound-guided biopsy
MRI-fusion guided biopsy
In-bore CT/MRI guidance
⚠️ Impact:
Urology & Radiology Alert
Documentation must clearly specify imaging guidance per lesion to ensure accurate reimbursement.
SLIDE 3: TELEHEALTH & REMOTE MONITORING EXPANSION
(Existing codes like 99454 remain, but major revenue expansion begins.)
OLD RULES:
Device supply required 16+ days of monitoring (e.g., 99454)
Treatment management required 20+ minutes (e.g., 99457)
NEW REVENUE OPPORTUNITIES:
5 New Codes (e.g., 99XX4, 98XX4–98XX6)
Device supply billable for 2–15 days of monitoring
New codes allow billing after the first 10 minutes of management time (e.g., 99470)
✅ Impact:
RCM WIN for Primary Care
Capture revenue for short-term monitoring and brief clinical interactions that were previously unbillable.
FINAL TAKEAWAY
CPT 2026 isn’t just an update—it’s a fundamental billing shift.
Practices that fail to update workflows, documentation, and coding logic risk denials, compliance issues, and lost revenue.
Prepare now to stay compliant and profitable in 2026!
📞 (516) 208-4446
📧 info@pmexinc.com | 🌐 pmexinc.com
