2026 brings significant changes to healthcare documentation, billing, and compliance. From 288 new CPT codes to stricter HIPAA security requirements, healthcare organizations must prepare now to avoid claim denials and compliance issues.
This guide consolidates all major 2026 updates into a single resource, with actionable timelines, checklists, and preparation steps to help your practice stay ahead.
2026 Implementation Timeline
ICD-10-CM FY2026 Updates
487 new diagnosis codes, 28 deletions, 38 revisions take effect
CPT 2026 Updates
288 new procedure codes, 84 deletions, 46 revisions
Medicare Physician Fee Schedule
New payment rates, APCM services, behavioral health codes
Medicare Advantage CY2026
5.06% payment increase, new documentation requirements
TEAM Model Launch
Mandatory surgical episode model for selected hospitals
ICD-10-PCS Updates
New procedure codes for inpatient settings
HIPAA Security Rule Final
24-hour breach notification, MFA required, all specs mandatory
2026 CPT Code Changes (January 1, 2026)
Radiology/Interventional
Major overhaul of lower extremity revascularization codes
Proprietary Lab Analyses
27% of new codes are advanced lab tests
AI-Augmented Services
New codes for AI-assisted physician services
Remote Patient Monitoring
New code for 2-15 days RPM, lower time threshold (10-20 min)
Immunization Counseling
New codes for vaccine counseling without administration
Flu/COVID Combination
New add-on code for combination vaccine administration
ICD-10-CM FY2026 Updates (Already Effective)
These codes took effect October 1, 2025 and are valid through September 30, 2026. Your systems should already be updated.
| Category | Changes | Examples |
|---|---|---|
| Injuries & Poisonings | New specificity for contusions, lacerations, puncture wounds, open bites | Poisoning by fluoroquinolone antibiotics, toxic effect of xylazine |
| Neurology | Major expansion with greater granularity | New body site and severity specifications |
| Behavioral Health | Expanded mental health diagnosis codes | Enhanced specificity for psychiatric conditions |
| Social Determinants of Health | New Z codes for SDOH documentation | Housing instability, food insecurity, transportation barriers |
| Guidelines Updates | Revised Excludes Notes, Code First/Use Additional instructions | New sections and subcategories across chapters |
2026 Medicare Updates
Part B Premium
$202.90/month (up from $185.00)
+$17.90Part B Deductible
$283/year (up from $257)
+$26MA Plan Payments
5.06% average increase
+2.83% from initial estimateProvider Directory
Must submit data to CMS Medicare Plan Finder
New requirementInpatient Reopening
Limited to obvious error or fraud only
Provider protectionNew Documentation Requirements
Risk Adjustment Data
Updated HCC definitions using general ICD terminology instead of specific versions
Provider Directory Attestation
Annual attestation of provider directory accuracy required
APCM Service Elements
13 service elements for Advanced Primary Care Management billing
Behavioral Health Integration
New add-on services for psychiatric collaborative care
Home Health Face-to-Face
Updated face-to-face encounter documentation policies
ICD-10 Specificity
Greater granularity required for injuries, neurology, behavioral health
2026 Preparation Checklist
Code Updates
- Update EHR/EMR code databases by December 31, 2025
- Review 288 new CPT codes for applicable specialties
- Implement 487 new ICD-10-CM codes (already effective Oct 1)
- Train coders on deleted and revised codes
- Update charge masters and fee schedules
Documentation Templates
- Update templates for new specificity requirements
- Add SDOH documentation fields
- Create APCM service element checklists
- Revise behavioral health integration templates
- Update injury documentation for new codes
Staff Training
- Schedule coder education on 2026 changes
- Train physicians on documentation specificity
- Update compliance training materials
- Review billing workflows for new codes
- Conduct mock audits using new requirements
System Updates
- Update billing software with 2026 codes
- Configure claim scrubbing for new edits
- Test electronic submissions with new codes
- Update provider directory submission processes
- Implement denial monitoring for new codes
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