CPT^® Coding Changes

Coverage of new CPT codes PROPOSED in the CY 2025 Medicare physician fee schedule proposed rule

We provide a review of CPT^® and CMS changes annually when updates are released. If needed for reference, changes from previous years are archived at the bottom of this article.

Watch for information about our annual CPT® Update webinar with special guest Shannon McCall coming in December.

Keep in mind, many of the following are placeholder codes. Proposed changes are listed in code order, so read to the end to see changes for Telemedicine Evaluation and Management (E/M) Services (placeholder codes 9X075 through 9X090), and COVID Immunization Administration (new CPT® code 90480.)

Skin Cell Suspension Autograft

Placeholder CPT codes: 15XX1, 15XX2, 15XX3, 15XX4, 15XX5, 15XX6, 15XX7, 15XX8

Descriptor:

• 15XX1 (Harvest of skin for skin cell suspension autograft; first 25 sq cm or less)
• 15XX2 (Harvest of skin for skin cell suspension autograft; each additional 25 sq cm or part thereof [List separately in addition to code for primary procedure])
• 15XX3 (Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; first 25 sq cm or less of harvested skin)
• 15XX4 (Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; each additional 25 sq cm of harvested skin or part thereof [List separately in addition to code for primary procedure])
• 15XX5 (Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; first 480 sq cm or less)
• 15XX6 (Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; each additional 480 sq cm or part thereof [List separately in addition to code for primary procedure])
• 15XX7 (Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 480 sq cm or less)
• 15XX8 (Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 480 sq cm or part thereof [List separately in addition to code for primary procedure])

2025 proposed fees: All codes carrier-priced

Key details: The code set, which the CPT Editorial Panel approved in September 2023, includes a series of codes for the harvest, preparation and application of skin cell suspension autograft services. The set includes 000-global base code (15XX1) with an add-on code (15XX2); an XXX global base code (15XX3) with add-on code (15XX4); and two 090-day global base codes (15XX5, 15XX7) with their respective add-on codes (15XX6, 15XX8).

The agency proposes contractor-pricing for the codes “due to concerns with the coding structure of the code family and the total physician time that results when these codes are billed multiple times on the same date of service for the typical patient.” CMS disagreed with the AMA’s RVS update committee (RUC) on the valuation of the services and noted that the RUC is planning to re-review the work and practice expense relative value units (RVU) in 2026 or 2027. CMS also adds that the services described in the new codes are currently billed under CPT code 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue) and expects “very low utilization” of the eight new codes.

Hand, Wrist and Forearm Repair and Recon

Placeholder CPT code: 2X005

Related codes in series: 25310, 25447, 26480

Descriptor: 2X005 (Arthroplasty, intercarpal or carpometacarpal joints; suspension, including transfer or transplant of tendon, with interposition, when performed)

2025 proposed facility fees: 2X005 ($880.09)

Key details: A new bundled code that the CPT Editorial Panel approved in May 2023, 2X005 is intended to report intercarpal or carpometacarpal joint suspension arthroplasty, including transfer or transplant of tendon, with interposition. CPT revised code 25447 to clarify that the code only included interposition of a tendon and not suspension.

CAR-T Therapy Services

Placeholder CPT codes: 3X018, 3X019, 3X020, 3X021

Descriptor:

• 3X018 (Chimeric antigen receptor T-cell [CAR-T] therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day)
• 3X019 (Chimeric antigen receptor T-cell [CAR-T] therapy; preparation of blood-derived T lymphocytes for transportation [eg, cryopreservation, storage])
• 3X020 (Chimeric antigen receptor T-cell [CAR-T] therapy; receipt and preparation of CAR-T cells for administration)
• 3X021 (Chimeric antigen receptor T-cell [CAR-T] therapy; CAR-T cell administration, autologous)

2025 proposed facility fees: 3X018 ($93.83), 3X019 ($37.86), 3X020 ($38.18), 3X021 ($170.84)

Key details: The new CAR-T therapy services codes, representing a type of immunotherapy for cancer treatment, replace the now-deleted series of Category III codes 0537T-0540T.

Intra-Abdominal Tumor Excision or Destruction

Placeholder CPT codes: 4X015, 4X016, 4X017, 4X018, 4X019

Descriptor:

• 4X015 (Excision or destruction, open, intra-abdominal [ie, peritoneal, mesenteric, retroperitoneal], primary or secondary tumor[s] or cyst[s], sum of the maximum length of tumor[s] or cyst[s]; 5 cm or less)
• 4X016 (Excision or destruction, open, intra-abdominal [ie, peritoneal, mesenteric, retroperitoneal], primary or secondary tumor[s] or cyst[s], sum of the maximum length of tumor[s] or cyst[s]; 5.1 to 10 cm)
• 4X017 (Excision or destruction, open, intra-abdominal [ie, peritoneal, mesenteric, retroperitoneal], primary or secondary tumor[s] or cyst[s], sum of the maximum length of tumor[s] or cyst[s]; 10.1 to 20 cm)
• 4X018 (Excision or destruction, open, intra-abdominal [ie, peritoneal, mesenteric, retroperitoneal], primary or secondary tumor[s] or cyst[s], sum of the maximum length of tumor[s] or cyst[s]; 20.1 to 30 cm)
• 4X019 (Excision or destruction, open, intra-abdominal [ie, peritoneal, mesenteric, retroperitoneal], primary or secondary tumor[s] or cyst[s], sum of the maximum length of tumor[s] or cyst[s]; greater than 30 cm)

 2025 proposed facility fees: 4X015 ($1280.66), 4X016 ($1,634.64), 4X017 ($1,953.67), 4X018 ($2,272.70), 4X019 ($2,800.75)

Key details: The series of five new intra-abdominal tumor excision or destruction codes describes the sum of the maximum length of tumors or cysts, from 5 cm or less (4X105) to more than 30 cm (4X109) in length. The new codes will replace existing codes 49203-49205, which were based on the size of the “largest tumor” as opposed to the sum of total length of total tumors, cysts or endometria involved.

Bladder Neck and Prostate Procedures

Placeholder CPT codes: 5XX05, 5XX06

Descriptor:

• 5XX05 (Cystourethroscopy with insertion of temporary device for ischemic remodeling [ie, pressure necrosis] of bladder neck and prostate)
• 5XX06 (Catheterization with removal of temporary device for ischemic remodeling [ie, pressure necrosis] of bladder neck and prostate)

2025 proposed non-facility fees: 5XX05 ($2,619.88), 5XX06 ($138.81)

2025 proposed facility fees: 5XX05 ($160.16), 5XX06 ($80.24)

Key details: The two new codes “describe the insertion or removal of a temporary device to remodel the bladder neck and prostate using pressure to create necrosis and relieve lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH),” CMS states in the proposed rule. Both codes are 000-day global, and CMS is fine-tuning the professional fees based on a question about supplies: “We are seeking comments on whether a total of three SB027 impervious staff gowns and two SB024 pairs of sterile gloves would be typical and necessary when providing this procedure,” the agency says.

MRI-Monitored Transurethral Ultrasound Ablation of Prostate

Placeholder CPT codes: 5X006, 5X007, 5X008

Descriptor:

• 5X006 (Insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed)
• 5X007 (Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation)
• 5X008 (Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed)

2025 proposed non-facility fees: 5X006 ($533.88), 5X007 ($8,654.31), 5X008 ($8,951.34)

2025 proposed facility fees: 5X006 ($211.29), 5X007 ($474.99), 5X008 ($582.74)

Key details: The three new codes, approved at the April 2023 CPT Editorial Panel meeting, cover MRI-monitored transurethral ultrasound ablation (TULSA), a nonsurgical procedure intended to treat prostate cancer and an enlarged prostate.

Guided High Intensity Focused Ultrasound

Placeholder CPT code: 6XX00

Descriptor: “Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed.”

2025 proposed fee: $1,037.99

Key details: Replacing Category III code 0398T, new Category I code 6XX00 describes “magnetic resonance image guided high intensity focused ultrasound intracranial ablation for treatment of a severe central tremor,” and is a service typically performed by a neurosurgeon who is aided by a separate radiologist, according to CMS.

Percutaneous Radiofrequency Ablation of Thyroid

Placeholder CPT codes: 6XX01, 6XX02

Descriptor:

• 6XX01 (Ablation of 1 or more thyroid nodule[s], one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency)
• 6XX02 (Ablation of 1 or more thyroid nodule[s], additional lobe, percutaneous, including imaging guidance, radiofrequency [List separately in addition to code for primary procedure])

2025 proposed non-facility fees: 6XX01 ($2,393.71), 6XX02 ($386.01)

2025 proposed facility fees: 6XX01 ($303.82), 6XX02 ($210.32)

Key details: Featuring a primary code and add-on code, this new series describes the ablation of one or more thyroid nodules. CMS accepted and proposed the RUC-recommended work and practice expense RVUs for the two codes.

Fascial Plane Blocks

Placeholder CPT codes: 6XX07, 6XX08, 6XX09, 6XX10, 6XX11, 6XX12

Related codes in series: 64486, 64487, 64488, 64489

Descriptor:

• 6XX07 (Thoracic fascial plane block, unilateral; by injection[s], including imaging guidance, when performed)
• 6XX08 (Thoracic fascial plane block, unilateral; by continuous infusion[s], including imaging guidance, when performed)
• 6XX09 (Thoracic fascial plane block, bilateral; by injection[s], including imaging guidance, when performed)
• 6XX10 (Thoracic fascial plane block, bilateral; by continuous infusion[s], including imaging guidance, when performed)
• 6XX11 (Lower extremity fascial plane block, unilateral; by injection[s], including imaging guidance, when performed)
• 6XX12 (Lower extremity fascial plane block, unilateral; by continuous infusion[s], including imaging guidance, when performed)

2025 proposed non-facility fees: 6XX07 ($119.39), 6XX08 ($221.96), 6XX09 ($138.48), 6XX10 ($338.77), 6XX11 ($113.25), 6XX12 ($219.38)

2025 proposed non-facility fees: 6XX07 ($63.09), 6XX08 ($73.45), 6XX09 ($70.54), 6XX10 ($77.01), 6XX11 ($56.62), 6XX12 ($70.54)

Key details: With six new Category I codes, this series describes thoracic or lower extremity fascial plane blocks via injections or continuous infusion. The fascial plane blocks are typically used for post-operative pain management.

Iris Procedures

CPT codes: 6X004

Related codes in series: 66680, 66682

Descriptor:

• 6X004 (Implantation of iris prosthesis, including suture fixation and repair or removal of iris, when performed)

2025 proposed facility fee: 6XX04 ($741.60)

Key details: In an effort to simplify reporting, the CPT Editorial Panel deleted three Category II codes (0616T-0618T) and replaced them with 6X004, which describes the “insertion of an artificial iris into an eye with a partial or complete iris defect due to a congenital defect or surgical or non-surgical trauma,” CMS states.

Magnetic Resonance Examination Safety Procedures

Placeholder CPT codes: 7XX00, 7XX01, 7XX02, 7XX03, 7XX04, 7XX05

Descriptor:

• 7XX00 (MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources [eg, surgical reports, imaging reports, medical device databases, device vendors, review of prior imaging], analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report; initial 15 minutes)
• 7XX01 (MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources [eg, surgical reports, imaging reports, medical device databases, device vendors, review of prior imaging], analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report; each additional 30 minutes [List separately in addition to code for primary procedure])
• 7XX02 (MR safety determination by a physician or other qualified health care professional responsible for the safety of the MR procedure, including review of implant MR conditions for indicated MR examination, analysis of risk vs clinical benefit of performing MR examination, and determination of MR equipment, accessory equipment, and expertise required to perform examination, with written report)
• 7XX03 (MR safety medical physics examination customization, planning and performance monitoring by medical physicist or MR safety expert, with review and analysis by physician or other qualified health care professional to prioritize and select views and imaging sequences, to tailor MR acquisition specific to restrictive requirements or artifacts associated with MR conditional implants or to mitigate risk of non-conditional implants or foreign bodies, with written report)
• 7XX04 (MR safety implant electronics preparation under supervision of physician or other qualified health care professional, including MR-specific programming of pulse generator and/or transmitter to verify device integrity, protection of device internal circuitry from MR electromagnetic fields, and protection of patient from risks of unintended stimulation or heating while in the MR room, with written report)
• 7XX05 (MR safety implant positioning and/or immobilization under supervision of physician or other qualified health care professional, including application of physical protections to secure implanted medical device from MRinduced translational or vibrational forces, magnetically induced functional changes, and/or prevention of radiofrequency burns from inadvertent tissue contact while in the MR room, with written report)

2025 proposed non-facility fees: 7XX00 ($10.03), 7XX01 ($46.27), 7XX02 ($70.21), 7XX02-26 ($27.18), 7XX03 ($220.35), 7XX03-26 ($34.62), 7XX04 ($111.31), 7XX04-26 ($33.97), 7XX05 ($143.34), 7XX05-26 ($26.86)

Key details: This new code family describes “magnetic resonance (MR) examination safety procedures,” and it is intended to capture the physician work involved in managing patients who have implanted medical devices that require MR diagnostic procedures. For 2025, codes 7XX00 and 7XX01 consist of practice expense-only values, which “represent the preparatory research and review completed by clinical staff …that will be utilized by the physician or qualified health professional” when furnishing the four other services (7XX02-7XX05), CMS says. The clinical staff conducting the preparatory research is typically an MRI technologist or medical physicist, the agency says.

As part of the code family’s valuation, CMS is refining the clinical labor time for several activities, including CA021 (Perform procedure/service – NOT directly related to physician work time), which it proposes to limit to 14 minutes, and CA024 (Clean room/equipment by clinical staff), which would be halved to one minute.

Screening Virtual Colonoscopy

Newly active CPT code: 74263

Descriptor: 74263 (Computed tomographic [ct] colonography, screening, including image postprocessing)

2025 proposed fees: 74263 ($631.92), 74263-26 ($104.19)

Key details: CMS is assigning active payment status to colorectal cancer screening via computed tomography service code 74263. The outpatient prospective payment system (OPPS) cap would apply to the code. Originally introduced in 2010, the 74263 service was previously non-covered under Medicare. That will change effective Jan. 1, 2025, according to the proposed rule.

Telemedicine Evaluation and Management (E/M) Services

Placeholder CPT codes: 9X075, 9X076, 9X077, 9X078, 9X079, 9X080, 9X081, 9X082, 9X083, 9X084, 9X085, 9X086, 9X087, 9X088, 9X089, 9X090, 9X091

Descriptor:

• 9X075 (Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.)
• 9X076 ( … low medical decision making … ; 30 minutes must be met or exceeded.)
• 9X077 ( … moderate medical decision making … ; 45 minutes must be met or exceeded.)
• 9X078 ( … high medical decision making … ; 60 minutes must be met or exceeded.)
• 9X079 (Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.)
• 9X080 ( … low medical decision making … ; 20 minutes must be met or exceeded.)
• 9X081 ( … moderate medical decision making … ; 30 minutes must be met or exceeded.)
• 9X082 ( … high medical decision making … ; 40 minutes must be met or exceeded.)
• 9X083 (Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.)
• 9X084 ( … low medical decision making … ; 30 minutes must be met or exceeded.)
• 9X085 ( … moderate medical decision making … ; 45 minutes must be met or exceeded.)
• 9X086 ( … high medical decision making … ; 60 minutes must be met or exceeded.)
• 9X087 (Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.)
• 9X088 ( … low medical decision making … ; 20 minutes must be met or exceeded.)
• 9X089 ( … moderate medical decision making … ; 30 minutes must be met or exceeded.)
• 9X090 ( … high medical decision making … ; 40 minutes must be met or exceeded.)
• 9X091 (Brief communication technology-based service [eg, virtual check-in] by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion)

2025 proposed fees: 9X091 ($15.85); 9X075-9X090 are non-covered

Key details: CMS is opting not to cover 16 out of 17 new telemedicine codes that will appear in the 2025 edition of the CPT manual. The codes describe either audio-video or audio-only communications, with eight covering audio-video services (9X075-9X082) and eight codes for audio-only visits (9X083-9X090). Both sets of codes have options for new and established patients and they run on a range of medical decision-making, from straightforward to low to moderate to high. Essentially, there are four subsets of codes with four codes in each subset – four codes for audio-video visits for new patients (9X075-9X078); four codes for audio-video visits for established patients (9X079-9X082); four codes for audio-only services for new patients (9X083-9X086); and four codes for audio-only services for established patients (9X087-9X090).

CMS says in the proposed rule.

“The code descriptors and requirements for billing the codes generally mirror the existing office/outpatient E/M codes with the exception of the technological modality used to furnish the service,”

That is, aside from the delivery method (in person vs. virtual), the reporting requirements for the audio-video and audio-only codes would be the same as those for the E/M office visit codes.

However, CMS will not cover the new CPT codes in 2025, despite the termination of the current telehealth waivers that are set to expire on Dec. 31, 2024. “We do not believe that there is a programmatic need to recognize the audio/video and audio-only telemedicine E/M codes for payment under Medicare,” the agency states. CMS is assigning codes 9X075-9X090 a Procedure Status indicator it “I,” which means providers can find a more specific code for billing purposes – in this case, that would be existing E/M office visit codes with the appropriate place of service code attached.

CMS states:

“The introduction of new CPT coding to describe telemedicine E/M services does not change our authority to pay for visits furnished through interactive communications technology,”

In a related move, the CPT Editorial Panel deleted three E/M telephone codes (99441-99443), which had been temporarily assigned to CMS’ telehealth list.

New CPT code 9X091 – proposed as payable under Medicare Part B in 2025 – is intended to replace HCPCS code G2012 and takes the same descriptor as the HCPCS code (see above). To furnish the complete service described by 9X091, the practitioner must engage in five to 10 minutes of medical discussion. The expectation is that the service is patient-initiated, and the “brief virtual check-in encounter … is intended to evaluate the need for a more extensive visit,” CMS states. The agency proposed to delete code G2012.

Genetic Counseling Services

Placeholder CPT code: 9X100

Descriptor: “Medical genetics and genetic counseling services, each 30 minutes of total time provided by the genetic counselor on the date of the encounter.”

2025 proposed fee: Non-covered

Key details: Replacing CPT code 96040, new code 9X100 is proposed as a bundled service (Procedure Status “B”) and is intended to be reported by genetic counselors. CPT guidelines for the code disallow billing of the service for physicians and qualified health professionals who are eligible to bill for E/M services. CMS seeks feedback about the designation of the code’s procedure status.

COVID Immunization Administration

New CPT code: 90480

Descriptor: “Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, single dose.”

2025 proposed fee: $22.65

Key details: Streamlining the code set related to COVID-19 vaccine administration, the CPT Editorial Panel approved code 90480 on August 14, 2023, “for administration of new and existing COVID-19 products.” The single administration code replaces the various other COVID-19 vaccine administration codes and is applicable for all COVID-related vaccines.

Optical Coherence Tomography

Placeholder CPT code: 9X059

Related codes in the series: 92132, 92133, 92134,

Descriptor: 9X059 (Computerized ophthalmic diagnostic imaging [eg, optical coherence tomography (OCT)], posterior segment, with interpretation and report, unilateral or bilateral; retina, including OCT angiography)

2025 proposed fee: 9X059 ($57.27), 9X059-26 ($33.65)

Key details: An addition to the code family that includes 92132-92134, new code 9X059 “was created in response to new technology that allows imaging of the retina using optical coherence tomography (OCT) with and without non-dye OCT angiography (OCT-A),” CMS states in the proposed rule. The code was created during the February 2023 CPT Editorial Panel meeting.

Transcranial Doppler Studies

CPT codes: 93X94, 93X95, 93X96

Related codes in the series: 93886, 93888, 93892, 93893, 93890

Descriptor:

• 93X94 (Vasoreactivity study performed with transcranial Doppler study of intracranial arteries, complete [List separately in addition to code for primary procedure])
• 93X95 (Emboli detection without intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete [List separately in addition to code for primary procedure])
• 93X96 (Venous-arterial shunt detection with intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete [List separately in addition to code for primary procedure])

2025 proposed fees: 93X94 ($174.08), 93X94-26 ($39.15), 93X95 ($219.05), 93X95-26 ($35.59), 93X96 ($228.76), 93X96-26 ($41.74)

Key details: Comprising three add-on codes, the new series of transcranial Doppler studies codes (93X94, 93X95, 93X96) build on the existing code family that includes 93886, 93888, 93892, 93893 and 93890. The add-on codes would be billed “when additional studies are performed on the same date of service as a complete transcranial Doppler study,” according to CMS.

The agency states in the proposed rule:

“We note that the billing instructions for this code family specify that the three new add-on codes should be used in conjunction with CPT code 93886, and that CPT code 93888 should not be used in conjunction with CPT codes 93886, 93892, 93893, 93X94, 93X95 and 93X96,”

Keep an eye out for additional details from CPT; CMS wants clearer billing instructions for some of the involved codes.

The agency states:

“We believe that it would be beneficial for the CPT Editorial Panel to state more explicitly that CPT code 93X95 should not be used in conjunction with CPT code 93892 and that CPT code 93X96 should not be used in conjunction with CPT code 93893,”

“The work performed in the add-on codes would be duplicative of the base codes in these situations and result in unnecessary overbilling of services.”

 

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Previous years

2021 coding changes

See E/M changes and New and Newsworthy

2018 coding changes

If you need detailed information about CPT^® coding changes, there are two good sources.

• One costs a lot of money…attending the AMA’s CPT^® course in November of each year.
• For less money, you can buy a copy of CPT^® 2018 Changes: An Insider’s View. You can buy this book every year.

That is what I do, and I’m going to summarize what I’ve learned in this article. The book I am referencing is 244 pages long. This article, will provide a high level overview.

Get your CPT^® book out as your read this article!

E/M section | CPT^® changes

• The observation code descriptions got a slight change from “admission to observation status” to “outpatient hospital observation status.” This emphasizes the observation means that the patient is in an outpatient status.
• The domiciliary, rest home, or custodial care codes now include “Group home, custodial care and intermediate care facilities.”
• The anticoagulation management codes 99363 and 99364 were deleted. There are new codes in the medicine chapter related to anticoagulant management. I will get to those later.
• The text in the neonatal and pediatric critical care codes is now explicit about when to use 99291 and 99292. The neonatal and pediatric critical care codes are per day codes. One of physician bills those services for the care of the patient for a calendar day, a 24 hour period.  Physicians of the same specialty in the same group are paid is if they were one physician. CPT^® now explicitly says that a physician in the same group who is billing the neonatal and pediatric critical care codes may not also Bill 99291 and 99292.  Physicians of other specialties for providing critical care may bill 99291 and 99292 for a critically ill neonate or child.

Behavioral health and cognitive assessment | CPT^® changes

In 2017 CMS developed HCPCS codes for behavioral health collaborative care management and assessment of the patient with cognitive impairments. In 2018,  these are replaced by CPT^® codes.  I have written about these codes in separate articles. Links to those articles are at the end of this post.

99483 replaces HCPCS code G0505

99492 replaces HCPCS code G0502

99493 replaces HCPCS code G0503

+99494 replaces HCPCS code G0504

99484 replaces HCPCS code G0507

Anesthesia | New CPT^® codes

There are five new codes for anesthesia services for upper GI procedures, lower intestinal procedures, screening colonoscopy and a combined code.  Check your CPT^® book for the handful of deleted anesthesia codes.

00731 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified

00732     ERCP

00811 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum, not other specified

00812    screening colonoscopy

00813 Anesthesia for combined upper and lower GI endoscopic procedures, endoscope introduced both proximal and distal to the duodenum

Surgery | CPT^® code changes

Most of the changes to the surgery section (10000—69990) are in vascular codes.  But there are a scattering of changes in other chapters.

Two new skin codes

15730 Midface flap (ie, zygomaticofacial flap)with preservation of vascular pedicle (s)

15733 Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie. buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

+19294 Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy.  Use 19294 with 19301, 19302

There is a parenthetical notes added to some mastectomy codes to preclude reporting intraoperative placement of clip(s) separately

Musculoskeletal | new CPT^® code

+20939 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision

This is an add on code to a list of about 20 codes.  Look in your CPT^® book for the listing. 20939 may be reported bilaterally.

ENT | CPT^® code changes

There are new codes for nasal/sinus endoscopy and revisions to codes 31254, 31255 and 31276.

New codes

31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery

31253  Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed

31257  total (anterior and posterior), including sphenoidotom

31259  total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus

31298  Nasal/sinus endoscopy, surgical; with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation)

In addition, there is new commentary about the use of modifier 52 and 53 in the CPT^® book, at the start of the Endoscopy section.

It states that when performing 31231—31235, if not all of the components are performed because they are not clinically relevant or the clinician is unable (anatomy, technical difficult) and a repeat procedure is not scheduled, report the endoscopy with modifier 52.  If a repeat procedure is scheduled to perform all of the components report the endoscopy with modifier 53.

Pulmonary | CPT^® code changes

Code 31646 was revised to add the words “same hospital stay.”  31646 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay

There is a new code to report ablation of pulmonary tumors via cryoablation; 32998 now includes imaging guidance.

32994   Method of ablation: ablation therapy by cryoablation differentiated from radiofrequency ablation therapy

32998  Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; radiofrequency

There are three new codes for heart/lung transplants.  These were Category III codes in 2017 and were revised to reflect current clinical practice.  See 33927,  33928 and +33929.

Endovascular | CPT^® code changes

The EVAR (endovascular aneurysm repair). section got a major overhaul.

The new codes bundle related services into repair, including pre-procedure sizing and device selection, non-selective catheterizations and radiological supervision and interpretation.

• There are sixteen new codes, eight deleted codes and four revised codes.
• The new codes are in the series 34701—34812. These CPT^® codes have more detailed descriptions of vessels and what is included in the procedure. They are based on vascular anatomy and distinguish between repair for rupture and repair for other than rupture.
• Some exposure codes are changed from primary to add on codes.
• There is a new code for anchoring a graft and a code for using a large catheter.
• Vascular practices: read the CPT^® editorial comments, study the codes and contact the Society for Vascular Surgeons (vascular.org) with questions.

The codes for injection of sclerosant for sclerotherapy were revised for 2018.  (Look at codes starting with 36468.

• There are out of sequence codes in this series.
• There are many parenthetical comments regarding when imaging guidance may be reported, if the service may be reported more than once per extremity and what codes may not be reported.

CPT^® also provides a definition of compounding.

“Compounding is a practice in which a qualified health care professional (eg, pharmacist, physician) combines, mixes or alters ingredients of a drug to create a medication tailored to the needs of an individual patient.”

When performed in the office, all required supplies and equipment, and application of compression bandages and stockings are included in the fee for the procedure and should not be reported separately.

There are new codes (out of sequence) for endovenous ablation therapy.  See 36482 and +36483.

Bone marrow | CPT^® changes

There are two revised codes and one new code.   And, don’t forget the add-on code 20939 in the musculoskeletal section for bone marrow aspiration during spine surgery.

Revised codes

38220 Diagnostic bone marrow; aspiration (s)

38221 Diagnostic bone marrow biopsy (ies)

When aspiration is both diagnostic and biopsy, report new code

New codes

38222 Diagnostic bone marrow biopsy(ies) and aspiration(s)

Lymph nodes | New CPT^® code

New code

38573 laparoscopy, Surgical with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omenectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed. This code may not be reported with a long list of other procedures.  Take a look at the CPT^® book for the list.

Digestive system | New CPT^® codes and changes

There are three new codes in the digestive system for esophagectomy

• via an open and laparoscopic approach,
• via a thoracoscopic and laparoscopic approach and
• via a thoracosocpic, laparoscopic and open approach.

See codes 43286, 43287 and 43288.  These codes have work RVUs of 55, 63 and 66 respectively.  The first allows for a co-surgeon (per Medicare, of a different specialty) when documentation supports the need.   Co-surgeons are allowed for 43287 and 43288 (of a different specialty, per Medicare).

GU, male | CPT^® changes

Ligation of vas deferens, 55450 was deleted and users are instructed to use 55250, vasectomy instead.

New code

55874  Transperineal placement of biodegradable material, peri- prostatic, single or multiple injection(s), including image guidance, when performed.

GU, female | CPT^® changes

Three codes, 57240 anterior colporrhaphy, 57260, combined anteroposterior colporrhaphy and 57265, with enterocele repair now have “includes cystourethroscopy, when performed” in their definition.

New code

58575  Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed.

Nervous system | New CPT^® codes

Two new codes

64912  Nerve repair; with nerve allograft, each nerve, first strand (cable)

+64913  with nerve allograft, each additional strand (List separately in addition to code for primary procedure

Chest x-rays and abdominal x-rays were deleted and new codes added. Read about those changes in the article 2018 Radiology CPT^® code changes.

Pathology | CPT^® code revisions

The drug testing codes were revised, 80305, 80306 and 80307 to conform to the CPT^® format, without any change in meaning.

There are additional codes for Tier 1 and Tier 2 molecular pathology and new codes for mRNA expression testing.

Medicine section | CPT^® code changes

Vaccines

Vaccines are updated every six months.  In the 2018 book, there are new vaccine codes.

90756 Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use

90682 Influenza virus vaccine, quadrivalent [RIV4], derived from recombinant DNA, hemagglutinin [HA] protein only, preservative and antibiotic free, for intramuscular use

90587 Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use

90750 Zoster (shingles) vaccine (HZV), live for subcutaneous injection

Anticoagulation management

There are two new codes for caring for patients who are on anti-coagulation treatment.

The first is for training a patient/caregiver to do home INR monitoring. The second is for managing the patient. There is an article on CodingIntel that describes these.

Pulmonary

There are two new codes in the pulmonary section

94617  Exercise test for bronchospasm, including pre- and post- spirometry, electrocardiographic recording(s), and pulse oximetry

Includes pulmonary tests and electrocardiographic recordings

94618  Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed

Includes measurements of heart rate and oxygen levels (oximetry and oxygen titration), when performed

94620 was deleted, and 94621, cardiopulmonary testing, was revised.  If your practice performs cardiopulmonary testing, look at the parenthetical notes after code 94621. 94621 may not be reported with EKG, rhythm ECG, stress testing and some pulmonary function tests.

Ambulatory glucose testing

Ambulatory glucose testing got a new code and a revised code, to distinguish between equipment ownership.  Use 95250 when the physician owns the equipment.  95251 is used for the analysis, interpretation and report, and may not be reported more than once monthly.

There is a new code, 95249 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook- up, calibration of monitor, patient training, and printout of recording. Use 95249 when the equipment is not owned by the physician.

Photodynamic therapy

95930, visual evoked potential testing was revised, as was 96567 photodynamic therapy.

There are codes for non-surgical treatment of skin lesions.  There are two new codes.

96573  Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day

96574 Debridement of premalignant hyperkeratotic lesion(s) (ie, targeted curettage, abrasion) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day

Physical rehab

In the physical rehab section, there is a new code for interventions that focus on cognitive function.  Report this only once per day. 97532 was deleted.

97127  Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact.  This code has a status indicator of I (not valid for Medicare purposes) in the Medicare fee schedule, and no RVUs.

Orthotics | CPT^® code revisions

Two orthotics codes were revised to include the initial encounter, 97760 and 97761.

New code

97763  Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes, which may not be reported with 97760 or 97761.  97762 was deleted.

This is an overview | See these additional resources:

For details, look in your CPT^® book or buy a copy of CPT^® Changes: An Insider’s View.

More articles about CPT^® changes

Behavioral Health Links:

Psychiatric Collaborative Care Management Services

CPT^® code 99483: Cognitive assessment and care plan services