January 1st, 2026 is more than just a date on the calendar, it’s a major turning point for medical billing across every specialtyThat’s the day 418 CPT code changes go live across every specialty. We’re talking 288 brand new codes, 84 codes getting deleted and 46 revisions. Plus 487 new ICD-10-CM diagnosis codes dropping at the same time.
This isn’t one of those “minor updates” years. Remote monitoring is getting completely restructured. AI services are finally billable. Vascular procedures moved to territory-based coding. Even Medicare payment rules changed with that controversial efficiency adjustment.
Here’s what I know from working through these transitions: practices that start preparing in December are the ones scrambling in January. Their claims get denied. Payments get delayed. Staff gets frustrated trying to figure out what went wrong.
The practices that come out ahead? They started weeks ago. They already identified their exposure. Their systems are updated and tested. Their teams know exactly what changed.
So where does your practice stand right now? Let me show you how to get ready before new year hits.
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TALK TO AN EXPERTHow These Changes Actually Impact Your Practice Revenue
Your Documentation Requirements Just Changed
Remote patient monitoring used to require 30 days of data and 20 minutes of management time. Now you can bill for periods as short as 2-15 days with just 10 minutes of interaction.
What this means for you: Document differently or lose money. “Reviewed patient data” doesn’t meet the new requirements. You need specific dates monitored, parameters tracked and communication details recorded.
Real example: Your post-surgical patients can now generate RPM revenue during their critical two-week recovery period. But only if your documentation captures the new requirements.
AI-Assisted Services Need Specific Documentation
If your specialists use software to analyze imaging or assess risk, those services are now separately billable. The catch? Your current documentation probably doesn’t capture what payers need to see.
You must document the tool name, what data it analyzed and how your physician used that information for clinical decisions. Missing any of these three elements means denied claims.
Some Procedures Pay Less Despite Doing the Same Work
CMS implemented a 2.5% “efficiency adjustment” affecting 7,000+ codes. Yes, Congress added a 2.5% increase to offset it. But these don’t apply equally across specialties.
Interventional cardiology, vascular surgery and radiology took the biggest hits. Some complex procedures face effective rate cuts even with the increase.
What you need to do: Calculate your actual reimbursement changes using your specific procedure mix. When claims get processed, payers apply these adjustments based on specialty and procedure complexity.
How to Assess Your Practice’s Readiness Right Now
Week 1: Know Your Exposure (Takes 2 Hours)
Pull a report of your 50 highest-volume procedure codes from 2025. These represent roughly 80% of your revenue. Cross-check them against the deletion list.
Found deleted codes you bill frequently? That’s your risk level right there. Each one needs a replacement code mapped and staff trained on the new documentation requirements.
Build a simple spreadsheet: Current code, New code, Documentation changes, Training status. This becomes your transition roadmap.
Week 2: Check Your Systems (Takes 3-4 Hours)
Call your EHR vendor. Three questions:
- When does your 2026 update release?
- Does it include deleted code crosswalks?
- What’s the installation timeline?
Schedule installation before December 15th. You need testing time before January.
Also check: Does your billing software flag deleted codes? Will it stop claims from going out with wrong codes? These safeguards prevent disasters.
Week 3: Map Your Payer Timelines (Takes 2 Hours)
Not every insurance company updates January. Build a payer adoption matrix tracking your top 10 payers and when they’ll accept new codes.
Medicare typically updates on time. Commercial payers like Aetna, United and Cigna often lag 2-8 weeks. Knowing this prevents you from submitting claims that get automatically rejected.
Week 4: Update Your Templates (Takes 4-6 Hours)
Your current EHR templates don’t capture what 2026 codes require. Add specific fields for:
- Monitoring periods and days
- AI tool names and data sources
- Territory specifications for vascular procedures
- Complexity documentation for revised codes
This isn’t optional. Small documentation gaps create revenue leaks that compound fast. Practices with professional coding services often catch these template issues during their regular audits before they turn into denial patterns.
Your Team Training Strategy (Without Overwhelming Everyone)
Physicians Need 3 Things (Not Everything)
Focus training on the changes that directly impact their documentation:
- New time thresholds for monitoring services
- Required elements for AI-assisted procedures
- Complexity distinctions for revised codes
That’s it. Don’t dump 418 code changes on busy physicians. Give them the three things that affect their daily notes.
Billing Staff Need Different Training
Your billing team focuses on:
- Which codes got deleted and their replacements
- New bundling rules that trigger denials
- Payer-specific adoption timelines
- Appeal templates for new denial patterns
Front Desk Needs Basic Awareness
Reception doesn’t need to know every code change. They need to know:
- Which services require different scheduling now
- What to tell patients about new documentation
- When to flag certain procedures for billing review
Test Your Readiness Before January
If your software allows test claims, use it in December. Submit claims with new codes to your major payers and see what happens.
Track these metrics starting:
- Denial rate by new code
- Average days to payment
- Which payers are actually reimbursing
- Appeal success rates
First-week denials tell you exactly where your gaps are. Fix them fast before they compound. Practices with strong AR management processes can identify denial patterns quickly and prevent revenue loss before it becomes a bigger problem.
When Your Practice Needs Outside Support
You can handle this internally if you have:
- Dedicated billing staff with time for training
- Denial rates consistently under 5%
- Strong documentation processes already
- IT resources for system updates
Consider getting help if you’re dealing with:
- Current denial rates above 10%
- Staff already maxed out with daily work
- Multiple specialties affected differently
- Limited time before January 1st
Specialty practices face different challenges than primary care during these transitions. The complexity of your procedures determines how much support you need.
Your First Action This Week
Don’t try to tackle everything at once. Pick one task and complete it:
Option 1: Run that top-50 code report and identify your deleted codes
Option 2: Schedule your EHR vendor call today
Option 3: Build your payer adoption tracking spreadsheet
Small consistent progress prevents chaos. Which one will you start with?
Need help getting your practice ready?Medlife MBS handles system updates, staff training and denial management during major transitions. We’ve helped hundreds of practices navigate code changes without revenue disruption. Schedule a free readiness assessment to see where your gaps are.