Summer is in full swing, and while your providers may be dreaming of vacations, you’ve got your eye on something else—coding updates. As of July 1, 2025, several important coding changes have taken effect, and it’s a great time to make sure your team is up to speed. Whether your office specializes in primary care, orthopedics, behavioral health, or anything in between, staying current helps ensure clean claims, accurate reimbursement, and solid compliance.
Here’s what’s new—and what’s coming next.
✅ What’s New as of July 1, 2025
CMS rolled out its quarterly Hospital Outpatient Prospective Payment System (OPPS) update, which included:
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New HCPCS Codes for Vaccines and Drugs:
New billing codes were released for the latest COVID-19, RSV, and influenza vaccine formulations, as well as for newly approved medications and biologics. If your office administers injections, infusions, or vaccines, confirm that your EHR and billing software are using the updated codes. -
Category III CPT Code Additions (0948T–0987T):
These temporary tracking codes relate to emerging procedures and technologies—many relevant to multispecialty practices. Even if you’re not using them now, keep an eye on developments that may apply to future services. -
Revised Payment Rates and Pass-Through Status:
Reimbursement changes tied to new codes may affect your charge master or contract billing. If you’re seeing underpayments, check to ensure your claims reflect the correct July 1 rates.
Tip: Now’s a good time to review any outstanding denials from July forward—they may be linked to code changes.
🧠 Don’t Forget: We’re Over Halfway Through the FY 2025 ICD-10-CM Cycle
ICD-10-CM updates effective October 1, 2024, remain in place through September 30, 2025. These include:
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252 New Diagnosis Codes:
Greater specificity for behavioral health conditions, maternal care, and social determinants of health (SDoH) like housing insecurity and caregiver stress. -
Refinements to Mental Health Diagnoses:
Codes now better reflect severity levels for eating disorders and anxiety-related conditions—an especially important shift for behavioral health providers. -
SDoH Coding:
More practices are encouraged to capture social risk factors using Z codes. This can help with payer reporting and eligibility for certain value-based care programs.
🧭 Looking Ahead: What’s Coming in January 2026
While your focus is rightly on the here and now, this is also the time to start preparing for CPT 2026 and Medicare’s 2026 fee schedule, both of which will go into effect on January 1, 2026. Early details from CMS and the AMA include:
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Retirement of Audio-Only Telehealth Codes:
CPT codes 99441–99443 are on the way out. They’re being replaced by a set of new codes (98000–98016) designed to cover a broader range of telehealth and hybrid care services. -
New G-Codes for Primary Care & Behavioral Health:
Expect expanded billing options for caregiver training, behavioral integration, and team-based chronic care management. These codes are intended to better support practices delivering coordinated care. -
Proposed Fee Schedule Adjustments:
CMS has signaled another slight cut to the conversion factor. While it’s not final yet, practices should start reviewing how any change may affect their top-billed services.
Planning Tip: Mark a fall team meeting to review CPT and Medicare changes once the final rules are published (usually in November).
🛠 What You Should Do Right Now
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Double-Check Your Code Lists: Confirm your July 1 updates are reflected in your charge capture tools, superbills, and EHR templates.
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Monitor Denials and Payment Delays: Any sudden uptick might be linked to recent code changes—especially for vaccines or outpatient procedures.
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Train Your Staff: Hold a short refresher with your front desk and billing staff to make sure everyone is on the same page about current codes.
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Set a Date to Review 2026 Updates: Even though it’s summer, fall planning is right around the corner. Don’t let January sneak up on you.