Every year, CPT codes change. Most years, it’s annoying but manageable. But the 2026 CPT codes are different. Not only because doctors were taken away from the table. But because this wasn’t a routine update. It was a pretty big signal shift.
In summary, across CPT, HCPCS, and ICD-10, the message from CMS is now very clear: We will pay more for longitudinal patient continuity of case and less for procedural itemization.
If you’re in primary care, parts of this feel like long-overdue recognition. If you’re in procedural or interventional specialties, or are independent, parts of this feel like a direct hit. Either way, it impacts every physician in some direct or indirect manner.
The Big Picture
Here is the bad news. Despite Congress passing a 2.5% Medicare “increase” for 2026 that gain is neutralized or reversed for many physicians by a new -2.5% efficiency cut on procedural codes; bundling of previously billable services; and cuts to billable facility-based practice expenses. This has continued a recent trend for CMS.
Yet at the same time, there is some good news — CMS expanded care-management codes that pay monthly, don’t require minute counting, and reward continuity of care over throughput.
This is not accidental.
In broad strokes, we now see a bit of a paradox depending on where you sit in the physician spectrum:
- Primary care gets paid more for being available
- Proceduralists get paid less for doing things efficiently
Let's take a closer look.
7 Changes to CPT Codes in 2026 That You Need to Know
1) Vascular Surgery: Not a Tweak But a Rewrite
The biggest technical change in 2026 was the complete deletion of the lower extremity revascularization code family (37220–37235).
In their place come 46 new codes built around vascular anatomy, not procedures. This might not seem like a big deal on its face. But take it from a surgeon: it is. Because this isn’t just new codes. It’s a new way of thinking.
Surgeons now have to dictate every case as: Territory → Pathology → Intervention
The three vascular territories are: iliac, femoral/popliteal, tibial/peroneal. You can’t mix them casually. Each territory has its own logic. Each vessel matters. Miss one detail and the coder may not be able to save you. As a microvascular surgeon, I particularly wonder about the future impact on my specialty.
The money leaks out here in two main ways:
- Aggressive bundling: Access, catheterization, embolization, imaging are now all bundled. Revenue lines that many non-hospital procedural offices relied on are gone.
- No more stacking: Multiple vessels in the same territory no longer mean multiple base codes. Work RVUs therefore will compress fast.
This disproportionately hurts office-based labs, independent interventionalists, and practices without elite coding support.
Is this good or bad? I guess it depends on whether or not you think a hospital can provide these interventions (both diagnostic and therapeutic) more or less efficiently. Care certainly becomes somewhat more constrained as a result.
2) Primary Care: CMS Stopped the Stopwatch
While proceduralists got relatively more complexity, primary care got some needed relief.
APCM: Monthly Pay Without Minute Counting
Advanced Primary Care Management (APCM) codes now replace the old Chronic Care Model (CCM). CCM was used in primary care to manage chronic conditions expected to last at least 12 months like diabetes, heart failure, and hypertension through typically non-face-to-face interactions, including care coordination, 24/7 access to care, comprehensive care planning, and regular check-ins. It was a good idea but billing for it forced staff to track every phone call.
Now, with ACPM, it’s more about capability and continuity, not time logs. There are three levels for patients with zero to one chronic condition, two-plus chronic conditions, and two-plus chronic plus dual-eligible Medicaid. The highest tier pays meaningfully more because those patients create more administrative work.
But there is a catch: You need real access coverage, you need real care plans, and there has to be eligibility verification via the HIPAA Eligibility Transaction System.
Basically, primary care doctors will be compensated to build a mini population-health machine. This is, in my opinion, a worthwhile endeavor. But it is daunting to implement (at least coming from a non-PCP). Some PCPs will love that. Some may hate it. But it’s real money.
G2211 Finally Applies to Home Visits
Home-based PCPs managing complex patients were underpaid for years. But now the complexity add-on applies as long as the clinician serves as the primary, ongoing, longitudinal, focal point of care for the patient’s health needs.
This is obviously typical for primary care but also applies to specialists managing chronic conditions, opening up a potential opportunity for other specialties.
Expect EMR templates everywhere with the phrase: “Continuing focal point of care.”
3) AI Codes
2026 CPT codes formally recognize AI and AI-related work as billable. I think that’s good news.
The tricky but not un-expected news is buried in the fine print: the physician is still fully responsible. It’s a weird dynamic but I’m not sure it can be any other way. In fact, CMS and the AMA call AI “augmentative intelligence,” which essentially means AI can assist you, but you own the decision and the liability just like any other medical decision you make.
I certainly wouldn’t start copy-pasting an AI report into the chart without commentary or editing. But I still use AI in my practice and now will have to figure out how to properly code for it.
These codes may be great for tech-forward practices. However, practitioner beware: sloppy documentation turns them into malpractice bait.
4) RPM Finally Matches Reality
Remote patient monitoring (RPM) — which refers to remote devices that monitor chronic conditions for patients to help coordinate their care — used to have an all-or-nothing limit: the device had to be used for 16 days to be billed and compensated.
With the new changes however, shorter monitoring windows can be billed and management time thresholds dropped.
This makes billable RPM viable for post-discharge stabilization, short-term monitoring, and independent practices. Yes, it can still be operationally heavy. But no longer absurd or totally cost-prohibitive.
5) A Procedural Gut Punch
On top of code changes, CMS applied:
- A -2.5% efficiency cut to most procedural codes
- A 50% cut to indirect practice expense for facility-based work
The message this sends is brutal: If you got better at your job, CMS now assumes it takes less effort. Surgeons and others know this is not true. The patients who most need efficiency are older. Sicker. Heavier. More complex.
Independent surgeons feel this hardest because systems can subsidize losses, but private practices cannot.
This isn’t a neutral policy. It accelerates consolidation.
6) ICD-10: Documentation Inflation
The 2026 CPT codes introduce 614 new diagnosis codes. Clinically nothing changes. Administratively everything does. This is so much more red tape and potential areas of tripping up.
Wound care gets especially painful as laterality, depth, and tissue involvement need to be spelled out even more.
Again, more complexity favors consolidation. If it’s not spelled out, it didn’t happen and you won’t get paid. Comprehensive billing departments are needed. And missed codes and payments will hurt independent practices the most.
7) The Front Desk is the New Battleground
Medicaid work requirements and six-month redeterminations mean that eligibility now churns even more. Coverage can disappear mid-treatment and claims get denied retroactively. Quietly, front desks are turning into compliance hubs to make sure patients’ insurances are billed appropriately and the practice gets paid.
What this means outside of more billing complexity is that risk of staff burnout followed by physician burnout increases.
And again, small practices feel this more than anyone.
What Message Does This Send to Doctors?
Like the tax code represents governmental incentives for businesses and individuals, CMS changes incentivize doctors to practice the way the government wants us to.
Via these changes to the 2026 CPT codes, CMS is telling us exactly what it values: continuity over transactions, management over procedures, and systems over independents.
I'm not saying that all of these messages or changes are wrong. Continuity of care is important but lacking in the current health care system. Organization within the construct of health care is lacking. Primary prevention and management remains the foundation of health care and has been sorely underpaid and overlooked.
But we can't ignore the fact that we are robbing Peter to pay Paul. In this case, independent practitioners and proceduralists are Peter. And they still play a very important part in providing necessary and high quality care for patients.
There is a more important point here, however. As doctors, we cannot fall for the trap of thinking that this is all a zero-sum game. To help primary care physicians receive the value they deserve does not mean we have to take from surgeons, for example.
All doctors provide immense value and bring in significant money for the practices and systems they participate in. And yet, doctors’ compensation accounts for a minuscule part of the exorbitant rise in health care costs. Administrative cost however is a massive contributor. That is where our focus needs to be — not in blaming each other, but working together to correct the system.
When it comes to coding, 2026 will more than ever reward physicians who understand the rules, build workflows around them, and decide deliberately what kind of practice they want and then build that out. Pretending reimbursement doesn’t matter isn’t noble anymore. Ignoring it can only harm your practice. Understanding it and utilizing it efficiently gives us more immediate autonomy at an individual level as we continue to strive to improve it systemically.
What do these changes to the 2026 CPT codes mean for your practice? Share in the comments below!
Jordan Frey, MD is a plastic surgeon in Buffalo, NY at Erie County Medical Center and the University of Buffalo. His clinical focus is on breast reconstruction and complex microsurgery. He is also the founder of The Prudent Plastic Surgeon, one of the fastest growing finance blogs. There, he shares his journey to financial well-being with a goal of helping all physicians reach financial freedom, practicing on their own terms.
Collage by Diana Connolly
