With 2025 just around the corner, a fresh set of CPT (Current Procedural Terminology) code updates is set to take effect, bringing important changes for healthcare providers across various specialties.
Whether you’re in radiology, lab services, or telemedicine, these updates will reshape how services are coded, billed, and ultimately reimbursed—paving the way for more precise and efficient billing processes.
Cadence Collaborative is here to guide you through this transition, ensuring your practice is fully prepared to maximize the benefits of these changes.
Let’s explore what’s new and how these updates can enhance your revenue cycle.
What’s New in 2025 CPT Codes?
The American Medical Association (AMA) introduced 420 updates to the CPT code set for 2025, with 270 new codes, 112 deletions, and 38 revisions.
These changes reflect the growing complexity of medical procedures and the push for more accurate billing practices, covering innovations from genetic testing to advanced digital health monitoring.
Impact on Billing Procedures
So, what do these changes mean for your practice?
The primary goal of the 2025 updates is to reduce claim rejections by providing more precise coding that accurately reflects the services provided. Here’s how these updates can support your practice:
• More Accurate Reimbursement: With new and refined codes for areas like genetic testing and telemedicine, practices can align services more precisely with reimbursement requirements, minimizing back-and-forth with insurance providers.
• Streamlined Claims Processing: These updates simplify code selection, reducing errors and denials, and ultimately speeding up the revenue cycle for smoother, faster cash flow.
Major Additions, Deletions, and Modifications
Every year, some codes get added, some get modified, and others are deleted. This year’s focus is on clarity and precision:
• Additions: New codes for genetic testing, virtual care, and advanced radiology procedures.
• Modifications: Adjustments to existing codes, especially around complex lab tests, to reduce ambiguity.
• Deletions: Removal of outdated codes for procedures that no longer reflect current practices, to clean up the billing process.
These changes are about making billing simpler and more transparent, which is a win-win for providers and payers alike.
Key Updates by Service Type
In 2025, CPT code updates reflect evolving healthcare practices.
From clinical labs to telemedicine, mental health, and surgery, here’s a breakdown of the major updates and their impact on billing:
Clinical Laboratory Services
Laboratory services are fundamental in diagnosis and patient monitoring, and the 2025 CPT update brings a focus on genetic and molecular testing. Here’s what’s new:
- New Codes for Genetic Markers and Personalized Medicine Panels: The largest group of new codes in 2025 focuses on genetic testing, covering proprietary laboratory analyses (PLAs) used for precision medicine.
For example, novel codes categorize tests for specific genetic markers, making billing more accurate for tests commonly used in oncology and rare disease diagnostics.
- Deleted Outdated Codes: Removed codes for older testing methodologies help streamline billing by ensuring that only current, relevant tests are covered. Billing teams should note these retirements to avoid errors that could lead to denials.
Practical Insight: A regularly updated list of added and retired codes can assist lab teams in verifying that they’re using the correct codes, minimizing claim rejections and accelerating reimbursements.
Telemedicine and Remote Patient Monitoring
In our November newsletter, we shared some important updates regarding telemedicine and remote patient monitoring (RPM) that will take effect in 2025.
These changes are part of the broader 2025 CPT code updates, which include 420 overall modifications, with 270 new codes, 112 deletions, and 38 revisions.
Telemedicine Updates:
- Deleted Codes: The CPT codes 99441-99443 have been deleted. These codes previously covered telephone evaluation and management services provided by a physician or qualified healthcare professional to an established patient.
Their deletion reflects the shift towards more comprehensive virtual care methods, such as video consultations, which provide a more interactive and thorough patient experience.
- New Codes: Seventeen new codes (98000-98016) will be introduced to cover a wider array of telemedicine services. These new codes, effective from January 1, 2025, are designed to better align with the evolving landscape of virtual healthcare.
They focus on synchronous communication technology (real-time audio and video), allowing for more precise billing of telehealth interactions that were previously harder to categorize under older codes.
Practical Insight: Double-checking that virtual visits align with these new telemedicine codes helps avoid mistaken billing for in-person services, leading to faster reimbursements and fewer denials.
Remote Patient Monitoring (RPM) Updates
- Billing Limitations: Code 99453, which covers the initial setup and patient education on RPM devices, can now only be billed once per patient enrollment.
- Device Supply and Data Reporting: Code 99454 will cover the supply of devices, data collection, transmission, and reporting for a period of 30 days.
Additionally, a new code is being considered to cover 2-15 calendar days of collected and transmitted data. This change aims to offer more flexibility in billing for shorter monitoring periods.
These updates will allow healthcare providers to bill for telemedicine and RPM services more accurately, ensuring that practices can keep up with the growing demand for virtual care while maintaining compliance with updated coding standards.
Mental Health and Behavioral Services
To meet the growing demand for mental health services, CPT 2025 introduces codes that capture new mental health services, particularly for virtual settings and behavioral health integration:
- New Codes for Group Therapy and Extended Sessions: Specific codes now cover virtual and group-based mental health services, supporting practices that provide comprehensive behavioral health care.
For example:
CPT 96164: This code covers group therapy sessions for mental health patients, allowing practices to bill accurately for group interventions, and ensuring proper reimbursement for these types of sessions.
CPT 96165: This is an add-on code for additional group sessions for the same patient, used when a patient participates in more than one session within a treatment period. This code enables practices to document extended group therapy needs.
CPT 96167 and 96168: These codes apply specifically to extended family-focused sessions where the primary patient is a child or adolescent.
CPT 96167 covers an initial family therapy session with the patient present, while CPT 96168 serves as an add-on for additional family-focused sessions.
Practical Insight: Using these specialized mental health codes instead of broader ones can reduce claim denials and delays, ensuring that practices are accurately compensated.
Surgical and Procedural Codes
High-demand surgeries, particularly in orthopedics, now have updated codes that capture more detail about the procedure and patient complexity.
- New CAR T-Cell Therapy Codes: Codes such as 38225 and 38226 cover specific steps in CAR T-cell therapy, allowing for precise billing related to harvesting and preparation of blood-derived T cells. These codes reflect the growing mainstream status of this treatment, moving from Category III (emerging technologies) to Category I.
- Prostate Ablation and Thyroid Nodule Treatment Codes: Codes like 53881 and 60660 support advanced therapies such as MRI-guided transurethral ultrasound ablation, which helps oncologists accurately report procedures that previously lacked dedicated codes.
Why These Code Changes Are a Big Deal for Your Revenue Cycle
These new CPT codes aren’t just routine updates, they’re a real opportunity to make your revenue cycle run smoother and faster.
With clearer, more detailed codes for services like genetic testing, telemedicine, and mental health, you can get claims right the first time, cut down on frustrating denials, and speed up reimbursements.
Adapting to these changes now can save you a lot of hassle down the road. At Cadence Collaborative, we’re here to provide the expert support you need to navigate these updates with confidence.
Our team specializes in helping practices integrate new codes smoothly, ensuring your billing processes are accurate, fully compliant, and optimized for strong financial performance.
Best Practices for Implementing CPT Code Updates
Adopting new CPT codes doesn’t have to be a headache. With a few key strategies, providers can integrate these updates smoothly and keep operations running without a hitch.
Here are some best practices to help you stay compliant, reduce errors, and keep your revenue cycle moving efficiently.
1. Conduct Regular Audits
Routine audits are a great way to catch and fix any mistakes before they impact cash flow. With so many new codes, it’s easy for small errors to slip through. By auditing your billing process regularly, you can spot patterns and adjust quickly.
Tip: Schedule audits for the first few months after implementing the updates. Focus on areas with major changes, such as new procedural or telemedicine codes, and review any common issues your team may be encountering.
2. Use Technology to Your Advantage
Leveraging billing software and automation tools can make a huge difference in keeping claims accurate.
Many billing systems allow you to update CPT codes automatically and include built-in checks that alert staff to possible errors before a claim is submitted.
Tip: Consider investing in technology that integrates the latest codes and compliance requirements. Features like auto-coding suggestions or denial tracking can save time and prevent common mistakes.
3. Communicate with Payers Early
Proactively reach out to key payers and ask about any specific guidelines or variations they have for the new CPT codes. Understanding payer-specific nuances ahead of time can prevent headaches and denials down the line.
Tip: Keep a centralized document or guide that tracks each payer’s unique coding requirements for the 2025 updates.
Empower Your Practice with Up-to-Date CPT Coding
Keeping your practice aligned with the latest CPT updates can make a powerful difference in your revenue cycle.
With each update, you gain the opportunity to refine billing accuracy, reduce claim denials, and secure a more reliable cash flow.
Cadence Collaborative is ready to be your partner in this transition. Let’s work together to ensure your team is equipped to leverage these changes for maximum impact.
Contact us today! Give us a call at (401) 743-2428, and see how our expertise can turn these updates into real advantages for your practice.
