CY 2026 CPT and HOPPS Updates

The 2026 updates to CPT and the Hospital Outpatient Prospective Payment System have been released and are available for review. Now is the time to familiarize yourself with the changes brought about by the updates so you can hit the ground running when they become valid on January 1.

This is a summary showing the total number of new, deleted and revised CPT codes.

This table shows the breakdown of code updates by section of CPT.

This table shows the breakdown of code updates by CPT Surgery sub-sections.

2026 CPT Significant Updates by Section

The list below highlights some of the significant 2026 updates to CPT by Section.

Evaluation and Management:

• A new code, 99445, was created and codes 99453 and 99454 were revised to allow for reporting of remote monitoring of physiological parameters for smaller periods of time (2-15 days and 16 to 30 days)
• A new code was, 99470, was created to allow for remote physiologic monitoring treatment management for 10 to 19 minutes.

Radiology

• A new code, 75577, was added
  • This code reports procedure to measure and assess the level of severity of coronary atherosclerotic plaque from AI generated data from coronary CTA
  • This code replaces Category III codes 0623T-0626T

Pathology and Laboratory

• Nearly one-third of the new codes are additions to the Pathology and Laboratory Section. 79 of these are proprietary lab analysis codes.

Medicine

• New codes 90482-90484 report counseling for immunizations not administered on the same date of service
• New codes were released for immunizations for:
  • RSV
  • COVID-19
  • Influenza
• Codes reporting coronary therapeutic services and procedures underwent a major overhaul that, among other changes, deleted many add-on codes for procedures in additional vessels
• New codes 93415-93416 were created to report interrogation and programming of baroreflex activation therapy (BAT) modulation systems

Category III

• A large number of updates with 78 new codes, 21 codes deleted and 4 revised codes.
• Many new Category III codes relate to procedure performed on the cardiovascular and nervous systems

Surgery: Musculoskeletal

• Codes 27458 and 27713 were added to allow reporting of femoral and tibial osteotomies.
• New Category III codes 0999T – 1001T were added to report autologous muscle cell therapy.

Surgery: Cardiovascular

• New codes for endovascular repair of thoracic aorta
  • Additions to the services included as part of repair
  • Code 33882 added to report repair by branched endograft multipiece system with fenestration for left subclavian artery
• A complete overhaul of codes to report endovascular revascularization of lower extremities for occlusive disease.
  • Deletion of 16 codes
  • Addition of 46 new codes
  • Addition of new vascular territory -Inframalleolar
  • New terminology for type of lesion
  • New guideline specifying unsuccessful interventions are reported as diagnostic catheterization and angiography
• Many new Category III codes for cardiovascular procedures, including:
  • Three codes (0981T - 0983T) for wireless inferior vena cava hemodynamic monitoring
  • Four codes (0984T - 0987T) for intravascular imaging of cerebral vessels
  • Two codes (0994T – 0995T) for aortic wall stabilization drug therapy
  • One code, 1019T, for lymphovenous bypass

Surgery: Digestive

• One new code (43889) for endoscopic sleeve gastroplasty
• One new code (47384) for percutaneous irreversible, electroporation ablation of liver tumors
• Three new Category III codes (0964T-0966T) for procedures on to treat sleep apnea
• Three new Category III codes (0978T-0980T) for submucosal cryolysis therapy to treat snoring and obstructive sleep apnea

Surgery: Urinary and Male Genital

• Two new codes for procedures to treat benign prostatic hyperplasia
  • 52443 Anterior Prostate Commissurotomy
  • 52597 Waterjet Resection of Prostate
• Nine new codes for prostate biopsy with imaging guidance (55707-55715)
• Two new codes for laparoscopic prostatectomy (55868 -55869)
• One new Category III code, 0950T, for transrectal ablation of benign prostate tissue

Surgery: Nervous

• Three new codes related to lumbar decompression
  • 62230, +62331 Percutaneous Lumbar Decompression
  • +63032 Repair of Annular Defect
• Six new codes (64654-64659) to report procedures on baroreflex activation therapy (BAT) modulation systems
• 10 new codes related to neurostimulators
  • 0988T, 0989T Subcutaneous insertion, replacement or removal of integrated neurostimulation system for bladder dysfunction
  • 0968T, 0969T Insertion, replacement or removal of epicranial neurostimulation system
  • 1013T - 1015T Laparoscopic procedures on lower esophageal sphincter neurostimulators
  • 1016T - 1018T Analysis, programming and monitoring of lower esophageal sphincter neurostimulators

HOPPS Updates Highlights

Updates take effect on January 1 and are made public through release of the Hospital Outpatient Prospective Payment- Notice of Proposed and/or Final Rulemaking. As of November 25, 2025 CMS has finalized the updates for CY 2026 with release of the final rule which can be found at https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1834-fc.

All of the details about the HOPPS updates can be found in the final rule.

Notable Areas of Update for 2026

• CMS is making an overall increase of payment rates of 2.6% for 2026, which is the same as the increase in 2025. This is based on a 3.3% increase reduced by 0.7 percentage point for the productivity adjustment.
• The Conversion Factor for CY2026 is $91.415 for hospitals that meet outpatient quality reporting requirements. This is an increase of 2.3% over 2025.
• There are 3 new procedures or technologies being added to New Technology APCs
• 3 devices with pass-through status are expiring by 12/31/2025
• 2 new devices have qualified for pass-through payment through the alternative pathway approval process
• No new devices have qualified for pass-through payment through the traditional pathway approval process
• There are 541 codes being added to the ASC covered procedures list
• Three year phase out of the Inpatient Only (IPO) List
• CMS will pay separately for the provision of certain groups of skin substitute products as supplies when they are used during a covered application procedure paid under the PFS in the non-facility setting or under the OPPS
• Finalization of changes to the methodology used to calculate the CY 2026 Community Mental Health Center (CMHC) Partial Hospitalization Program (PHP), and Intensive Outpatient Program (IOP) costs based on 40 percent of the corresponding proposed hospital-based PHP and IOP costs
• 1 new status indicator is being added related to skin substitute products paid separately.

HCPCS Codes

• Quarterly updates to HCPCS codes are ongoing. Many HCPCS codes are “hard” coded in the chargemaster. Check with your organization to determine which HCPCS codes are in the chargemaster, and which are assigned by coders.

Access the latest version of HCPCS here: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update

Prepare Now

Make sure you and your team are ready on January 1, 2026, to apply all of the CY2026 code and payment updates!

Enroll now in HIAlearn’s CY 2026 CPT Updates and HOPPS Updates Coding Course. Approved by AHIMA and AAPC for 1.5 CEUs.

Combine with ICD-10 and IPPS updates to get comprehensive update information:

• FY 2026 ICD-10-CM Code Updates (1.5 CEUs)
• FY 2026 ICD-10-PCS Code Updates (1.0 CEUs)
• FY 2026 Inpatient Prospective Payment System (IPPS) Updates (1.5 CEUs)

Bundle all four courses, and receive one free.

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.