- Effective window covers FY 2026 ICD-10-CM encounters and discharges from October 1, 2025, through September 30, 2026, with chapter notes and official coding guidelines to review before going live.
- Volume and intent add 400+ new diagnosis codes to improve specificity, reflect clinical advancements, and strengthen public health reporting for better data quality and downstream payment accuracy.
- Action steps include team training, refreshed documentation workflows, real-time EHR edits, and alignment to payer rules covering required modifiers and POS to support clean claims, predictable reimbursement, and patient care.
Medical coding has seen updates across each code set for 2025, and includes some code updates for 2026: ICD-10-CM diagnosis, CPT procedures, and HCPCS Level II supplies and services. The changes add new codes and notes to improve accurate reporting, cleaner claims, and reimbursement.
Medical coding updates help healthcare providers and billers capture the full story of every encounter each year. These codes, along with other claim details, record the who, what, where, when, and why of patient care.
Understanding the changes and reporting accurate codes may promote clean claims, strengthen data analytics and population health efforts, and support patient care. It also protects reimbursement and reinforces revenue cycle management.
Read on to learn about essential medical coding updates for the rest of 2025.
What's included in the medical coding updates for 2025 and 2026?
The three core code sets shape FY 2026 medical coding updates and how claims capture a clinical story. These medical codes help payers and providers align documentation, medical services, and reimbursement.
- CPT codes define outpatient procedures and services that clinicians report to payers.
- ICD-10-CM codes explain why care is delivered and capture severity and risk, following the International Classification of Diseases (ICD-10).
- ICD-10-PCS codes. ICD-10-PCS describes inpatient procedures performed during a hospital stay.
- ICD-10-PCS codes describe inpatient procedures performed during a hospital stay.
- HCPCS Level II codes (the Healthcare Common Procedure Coding System) identify supplies, drugs, and certain professional services using an HCPCS code.
Together, these code sets support accurate coding across inpatient and outpatient settings. As you prepare for FY 2026, confirm coverage using Medicare's list of telehealth services for calendar year (CY) 2025, which remain billable under the Physician Fee Schedule when furnished via telehealth through December 31, 2025.
Medical coding updates for 2025 and 2026
Read on to learn about this year's essential medical coding updates.
New CMS codes: ICD-10-CM changes for 2026
FY 2026 introduces 400+ new ICD-10-CM diagnosis codes for encounters and discharges from October 1, 2025, through September 30, 2026. Review the official ICD-10-CM files and the FY 2026 ICD-10-CM coding guidelines to confirm chapter notes, Excludes instructions, and sequencing rules. Updates aim to increase specificity, support public health reporting, and reflect clinical advancements.
Representative additions include:
- Type 2 diabetes mellitus in remission (E11.A): Adds a code to document confirmed remission status.
- Hyperoxaluria subtypes: New options distinguish inherited and acquired forms to improve tracking and care planning.
- Multiple sclerosis phenotypes: Codes differentiate clinical courses to capture disease progression and prognosis.
- Thyroid eye disease: New codes separate TED from underlying endocrine disorders for more precise reporting.
- Immune complex–mediated membranoproliferative glomerulonephritis: Adds codes aligned with updated pathology and classification
Remember that ICD-10-PCS remains a separate inpatient procedure code set. If you submit facility claims, check potential MS-DRG impacts, and ensure hospital workflows are updated before October 1. The FY 2026 update also includes select revisions and deletions; see the complete files on the CMS ICD-10 code files page.
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New CPT codes: Updates across services and tech
There are 270 new CPT codes as of January 1, 2025. Highlights include:
- Governance and overview. The American Medical Association (AMA) maintains Current Procedural Terminology through its Editorial Panel. See the AMA's CPT 2025 code set and the CPT coding resources hub.
- Telehealth and E/M. A new telemedicine subsection adds 17 codes for synchronous evaluation and management across new and established patients (audio-video and audio-only families). CPT 98016 replaces HCPCS G2012 for brief virtual check-ins. Confirm payer coverage, required modifiers, and place-of-service rules.
- Artificial intelligence (Category III). The AMA's Appendix S defines assistive, augmentative, and autonomous artificial intelligence. New Category III additions describe augmentative data analysis in imaging and physiologic measurements.
- Surgery, vaccines, and PLA. Updates include skin grafts for wound care (15011–15018) and abdominal tumor procedures (49186–49190), plus changes to vaccination codes and proprietary laboratory analyses.
- Education and payer rules. Keep teams current through AMA or AAPC webinars. Verify documentation for evaluation and management and apply payer-specific modifiers.
For CY 2026, the CPT code set will take effect on January 1, 2026. Confirm coverage and documentation details against the released materials and payer policies once published.
Beginning January 1, 2026, 6 new CPT codes will cover the first 2–15 days of remote patient monitoring:
- 99XX4: Remote physiologic monitoring device supply
- 99XX5: Remote physiologic monitoring treatment management services
- 98XX4: Respiratory remote patient monitoring
- 98XX5: Musculoskeletal remote patient monitoring
- 98XX6: Cognitive behavioral therapy remote patient monitoring
- 98XX7: Remote therapeutic monitoring treatment management services
New HCPCS Level II codes: Quarterly changes and billing impact
The Healthcare Common Procedure Coding System helps payers and providers align supplies, drugs, and certain professional services with payment policy and reimbursement rules from the Centers for Medicare & Medicaid Services.
CMS will issue HCPCS Level II quarterly files for January 2026 as part of its standard release cycle; verify new, revised, and discontinued codes in the official quarterly update when posted.
There are 309 HCPCS Level II codes effective January 1, 2025. They include:
- 2 new A codes for transportation, medical and surgical supplies, and administrative services
- 30 new C codes for outpatient services
- 19 new E codes for durable medical equipment
- 112 new G codes for professional services reported to Medicare
- 2 new H codes for alcohol and substance use treatment and rehab services
- 37 new J codes for non-oral administered drugs.
- 79 new M codes for medical services
- 28 new Q codes for temporary reporting for a range of services and supplies
Review these new HCPCS codes to determine whether you may be able to generate additional revenue:
- G0556–G0558 for advanced primary care management services
- G0559 for post-operative care services furnished by a practitioner other than the one who performed the surgical procedure (or another practitioner in the same group practice)
- G0552–G0554 for digital mental health treatment device supply and treatment management services
Here's a good summary of the CY 2025 Medicare Physician Fee Schedule Final Rule that explains how to bill these and many other new codes. Be sure to review this concise document with your medical coding and billing teams, as well as physicians and other providers in the medical practice.
To learn more about HCPCS Level II coding updates, visit HCPCS Quarterly Update | CMS.
How to prepare people, processes, and tech for the 2026 coding updates
Education, education, education. Equip teams to apply the 2025 code sets consistently, then reinforce with checks that protect reimbursement and patient care across private medical practices.
Here are tips for aligning people, process, and technology to ensure accurate, compliant coding under the 2025 updates:
- Team training. Schedule CPC and AAPC webinars and internal huddles so medical coders and billing staff can review new and revised codes together. Tie lessons to real claims from your healthcare industry specialty, and document takeaways for medical billing playbooks.
- Workflow audits. Map intake, documentation, charge capture, and submission workflows. Validate accurate coding, diagnosis specificity, E/M selection, and required modifiers. Track claim denials by reason and close gaps to support revenue cycle management.
- EHR rules and real-time checks. Enable real-time edits, code crosswalks, and claims scrubbing in your EHR software. Use alerts for missing documentation, incorrect code pairs, and payer-specific requirements so errors are fixed before submission.
- Stay current. Follow CMS's ICD-10-CM files, the AMA's CPT coding resources, and CMS's HCPCS Quarterly Update for FY/CY 2026 code changes and official guidance.
Make 2026 updates work for your practice
Staying current with 2026 updates helps providers code confidently and keep reimbursement predictable. Ask teams to confirm diagnosis, procedure, and supply codes, check evaluation and management rules, and apply required modifiers, place of service (POS), documentation, and payer policies before submission. Review denials weekly, refresh training, and use your EHR for real-time checks to catch issues early and protect patient care.
Stay up to date with The Intake for more insights into evaluation and management, modifiers, and payer rules. You'll find recent, practical guidance on keeping your workflows and claims in check.
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- Current Version – Oct 29, 2025Written by: Jean LeeChanges: This article was updated to include the most relevant and up-to-date information available.
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