Are CPT codes changing in 2026?

The AMA CPT 2026 code set introduces 418 total editorial changes, which include 288 new codes, 84 deletions, and 46 revisions effective January 1, 2026. CPT (Current Procedural Terminology) codes are standard numbers doctors use to report medical procedures and services.

Major 2026 CPT Code Updates

Digital Health and Artificial Intelligence (AI)

• Remote Patient Monitoring (RPM): Added five new short-duration codes for monitoring patients over 2 to 15 days in a 30-day period.
• Management Time: Added two new codes to report management services lasting only 10 minutes in a calendar month.
• AI Services: Introduced new codes for AI tools that help evaluate coronary plaque, perivascular fat, burn imaging, and cardiac dysfunction.

Surgery and Procedures

• Leg Revascularization: Deleted old lower-extremity revascularization codes and replaced them with 46 new territory-specific codes (37254–37299).
• Hearing Devices: Replaced older methods with 12 new codes for hearing device services.

Laboratory and Emerging Tech

• Proprietary Laboratory Analyses (PLA): Advanced genomics and specialized lab tests make up 27% of all new codes.
• Category III Codes: Temporary codes for emerging technology also make up 27% of the new additions. You can review professional training options through AAPC Workshops to learn more about application details.

Five common Current Procedural Terminology (CPT) codes used in routine medical practice include office visits, lab tests, and basic evaluations.

Common CPT Codes

• 99213: Office or other outpatient visit for the evaluation and management of an established patient, typically lasting 20 to 29 minutes.
• 99214: Office or other outpatient visit for an established patient, typically lasting 30 to 39 minutes with a moderate level of medical decision-making.
• 36415: Routine venipuncture, meaning drawing blood from a vein using a needle.
• 93000: Routine electrocardiogram (ECG/EKG) tracing with at least 12 leads, including the interpretation and report.
• 71045: Chest X-ray, single view.

The Current Procedural Terminology (CPT) code set is divided into six main sections under Category I, which cover standard medical procedures and services.

The 6 Sections of CPT Codes

• Evaluation and Management (E/M): Covers doctor visits, consultations, and routine checkups (such as office visits).
• Anesthesia: Covers pain management and administration of local or general anesthesia during procedures.
• Surgery: The largest section, covering operations and invasive procedures performed by surgeons or medical staff.
• Radiology: Covers imaging tests like X-rays, MRIs, CT scans, and ultrasounds.
• Pathology and Laboratory: Covers blood tests, biopsies, and tissue analysis processed in a lab.
• Medicine: Covers non-surgical treatments and services, such as physical therapy, vaccinations, and injections.

(Note: While Category I contains these six major sections, the broader CPT system also includes Category II codes for performance tracking and Category III codes for emerging technology).

Yes, the healthcare industry faces a persistent shortage of qualified medical billers and coders, driven by high turnover, an aging workforce, and growing administrative complexity.

Current Industry Demands

• Staffing Deficits: Industry groups like the American Health Information Management Association (AHIMA) and surveys by the Medical Group Management Association (MGMA) report ongoing gaps, with many healthcare providers struggling to fill revenue cycle management (RCM) roles.
• High Turnover: Internal billing departments often experience turnover rates between 11% and 40%, leaving facilities with lost institutional knowledge and delayed claims.
• Growing Complexity: Tighter payer compliance policies, constant updates to electronic health records (EHRs), and detailed medical coding requirements increase the demand for specialized training.

Differing Perspectives

On Reddit, opinions are mixed regarding the job market. While industry organizations and outsourcing reports emphasize a major deficit of certified professionals, some entry-level job seekers report difficulty finding open positions, noting that a severe shortage should theoretically yield more accessible entry-level hiring. However, consensus remains that specialized, experienced, and inpatient facility billers/coders are in short supply.

Organizations are increasingly turning to external vendors to mitigate severe in-house Staffing Shortages and reduce Billing Errors that cost hospitals billions annually.

The main difference between medical billing codes 99213 and 99214 is the complexity of the medical decision-making (MDM) and the total time spent with an established patient.

• 99213 represents a visit of low complexity lasting 20 to 29 minutes.
• 99214 represents a visit of moderate complexity lasting 30 to 39 minutes.

Key Comparison

How Providers Choose Between Them

Under current American Medical Association (AMA) guidelines, code selection is determined by either Medical Decision Making (MDM) or Total Time on the date of the encounter. History and physical exams are no longer required elements for selecting these outpatient codes, though they must still be documented as medically necessary.

1. Medical Decision Making (MDM)

MDM looks at three core elements, and you must meet at least two out of three to qualify for a specific level:

• Number and complexity of problems addressed:
  • 99213: Two or more stable minor illnesses, or one stable chronic illness.
  • 99214: Two or more stable chronic illnesses, one chronic illness with an exacerbation (worsening), or a new acute illness with systemic symptoms.
• Amount and/or complexity of data reviewed and analyzed:
  • 99213: Minimal or low data review.
  • 99214: Moderate data review, such as reviewing external notes or ordering independent tests.
• Risk of complications and/or morbidity/mortality:
  • 99213: Low risk of morbidity from treatment or diagnosis.
  • 99214: Moderate risk, such as prescription drug management or deciding on minor surgery with identified risk.

2. Time

If time is used to select the code instead of MDM, more than 50% of the total time spent on the encounter must be dedicated to face-to-face or non-face-to-face counseling and care coordination:

• 99213: Total time of 20–29 minutes.
• 99214: Total time of 30–39 minutes.