HCPCS Implementation Checklist for 2026

HCPCS Level II & CMS Guidelines

HCPCS January 2026 Update: Includes 160 new codes and 101 deletions. Notable additions include new J-codes for FDA-approved products and M-codes for telehealth-conducted encounters.

CMS Terminology Shift: CMS is beginning to phase out the term “Social Determinants of Health” in favor of “upstream drivers” in certain official descriptors.

NCCI Policy Revisions: As of January 1, 2026, 3D rendering (e.g., 76376) may no longer be reported specifically for mapping sites of multiple biopsies under radiologic guidance.

 Checklist for 2026

1. 1. Update Charge Masters: Ensure all deleted LER and MS codes are replaced to avoid immediate denials.
   2. Audit Remote Monitoring: Update workflows to capture 10-minute treatment management thresholds.
   3. Document AI Use: Ensure medical records specify if augmentative AI software was used for cardiology or imaging interpretations.

1. Key Behavioral Health & Telehealth G-Codes

New codes facilitate better integration and monitoring of mental health services:

• • G0568–G0570: New codes for Psychiatric Collaborative Care Management (CoCM) and Behavioral Health Care Planning.
  • G0660–G0668: A new series for TEAM remote evaluation and management (E/M) services, aligning with current outpatient E/M timeframes (e.g., G0660 for 10 minutes, G0664 for 60 minutes).
  • G9871: A specific code for online diabetes prevention behavioral counseling (60 minutes).
  • M1426, M1431, M1436+: New M-codes specifically to identify encounters conducted via telehealth across various specialties.

2. Medical Supplies & Catheter Updates (A-Codes)

CMS has phased out generic catheter coding in favor of more specific classifications:

• • A4295: Intermittent urinary catheter; straight tip, hydrophilic coating.
  • A4296: Intermittent urinary catheter; coude (curved) tip, hydrophilic coating.
  • A4297: Intermittent urinary catheter; hydrophilic coating, with insertion supplies.

3. New Injectable Drugs & Biosimilars (J & Q Codes)

A significant portion of the 160 new codes are found in the J and Q sections for advanced therapies:

• • J0013: Esketamine nasal spray, 1 mg (replaces discontinued S0013).
  • J1073: Testosterone pellet, implant, 75 mg (replaces discontinued S0189).
  • J3387: Injection, elivaldogene autotemcel, per treatment.
  • Q5160: Injection, bevacizumab-nwgd (Jobevne), biosimilar, 10 mg.
  • Q4411: AmnioMatrixF4X, human cell/tissue cover for wounds.

4. Remote Monitoring & Management Refinements

While foundational codes remain, 2026 adds flexibility for management:

• • Reduced Management Thresholds: New guidelines allow billing for just 10 minutes of clinical monitoring (e.g., CPT 99470) instead of the previous 20-minute minimum.
  • Short-Term Monitoring: New codes (such as CPT 99445) cover 2–15 days of reading per month, offering an alternative to the standard 16-day requirement for device supply.

5. Terminology & Administrative Changes

• • “Upstream Drivers”: CMS is officially phasing out the term “Social Determinants of Health” (SDoH) in descriptors (e.g., for codes G2076 and G2077) and replacing it with “upstream drivers”.
  • Permanent Telehealth: CMS has removed the distinction between “provisional” and “permanent” services on the Medicare telehealth list; all added services are now considered permanent.

HCPCS Level II updates include critical drug code crosswalks and the implementation of new specialty-specific MIPS Value Pathway (MVP) codes.

1. Discontinued J-Code Crosswalks (Effective Jan 1, 2026)

CMS has deleted several long-standing J-codes, often replacing them with more specific permanent codes or standardizing temporary S-codes into the J-series.

 2. MIPS Value Pathway (MVP) Codes (M1498–M1503)

CMS introduced a series of M-codes specifically to identify clinicians or groups participating in MIPS Value Pathways. These codes are used for administrative tracking of quality and cost performance within specific clinical specialties.

• • M1498: Diagnostic Radiology MIPS Value Pathway
  • M1499: Interventional Radiology MIPS Value Pathway
  • M1500: Neuropsychology MIPS Value Pathway
  • M1501: Pathology MIPS Value Pathway
  • M1502: Podiatry MIPS Value Pathway
  • M1503: Vascular Surgery MIPS Value Pathway

3. Notable Telehealth & Quality M-Codes

• • M1426, M1431, M1436+: Broad set of codes to identify encounters conducted via telehealth across different clinical scenarios.
  • M1482–M1485: New codes for tracking Hepatitis C treatment outcomes, specifically achieving “sustained virological response”.
  • M1492–M1497: Specific codes for Falls Risk Management, differentiating between patients who reported a fall and those with a documented plan of care.

4. Administrative Reminders

• • No Grace Period: Codes discontinued on December 31, 2025, are invalid for 2026 dates of service. Claims using deleted codes for services provided in January 2026 will be denied.