​As we approach the halfway point of 2025, it is time to begin looking forward to CY 2026. In preparation, there are several coding updates on the way from the American Medical Association (AMA) as part of the CPT® Editorial Panel Meetings, which concluded for 2026 in 2024. The summaries are published by the AMA on their website. 

​The following tables outline the changes we know to this point for specialties such as radiation oncology, diagnostic radiology, and interventional radiology with more information expected in the proposed outpatient rules from the Centers for Medicare and Medicaid Services (CMS) in July 2025 and the AMA publication of the 2026 CPT® manual, fourth quarter 2025. 

On March 15, 2025, the President signed into law the Full-Year Continuing Appropriations and Extensions Act of 2025 (H.R.1968) to maintain federal funding and extend temporary Medicare telehealth flexibilities through September 30, 2025, which is the end of the fiscal year (FY). However, this spending package excluded the so-called "doc fix" to reverse the 2.83 percent Medicare pay cut for physicians which was effective January 1, 2025.

​On Friday, January 31, 2025, a bipartisan coalition of lawmakers reintroduced a bill aimed at counteracting and surpassing a recent pay reduction for physicians that took effect at the beginning of the year. The Medicare Patient Access and Practice Stabilization Act of 2025, effective April 1, 2025, would continue the 2.83 percent Medicare pay reduction for services provided from January through March. However, starting April 1, 2025, through December 31, 2025, the legislation would implement a 6.62 percent increase, offsetting the previous payment cut and the impact of the first quarter’s reductions while adjusting for inflation. 

​On December 21, 2024, the American Relief Act (H.R. 10545) was signed into law. Among the key provisions is the extension of certain Medicare telehealth policy flexibilities for an additional 90 days, now set to expire on March 31, 2025. This extension ensures that Medicare beneficiaries can continue accessing telehealth services without interruption, maintaining the accessibility and convenience that have become essential for many, especially those in rural or underserved areas. 

​The President signed a critical spending bill, the American Relief Act, 2025 (H.R. 10545) on December 21, 2024, averting a government shutdown but leaving significant gaps in healthcare provisions. The bill has drawn mixed reactions, particularly from the healthcare sector, as several key measures included in earlier bipartisan resolutions were ultimately excluded. Among the retained provisions, acute hospital care at home and telehealth waivers received short-term extensions until March 31, 2025. However, this fell short of the original bipartisan proposal, which sought a five-year extension for acute hospital care and a two-year extension for telehealth services. Advocates have criticized the lack of long-term planning for these programs, which have been instrumental in expanding access to care during and after the COVID-19 pandemic. 

​A bipartisan group of House lawmakers recently introduced a bill that would reverse the impending 2.83 percent Medicare Physician Fee Schedule (MPFS) payment cut, which the Centers for Medicare and Medicaid Services (CMS) proposed  in July, and subsequently  finalized  in November in the 2025 MPFS final rule.

​The American Medical Association (AMA) released the 2025 CPT® code set on September 9, 2024. The development of new technologies and innovative procedures prompted most of the annual changes. Key updates include: 

• Addition of new E/M subsection for Telemedicine services and 17 new telemedicine codes;
• 5 new codes for open excision/destruction of intra-abdominal tumors;
• 6 new codes for thoracic fascial plane blocks;

​The Inflation Reduction Act of 2022 provided Medicare the ability to negotiate prices of certain “high cost, single source drugs without generic or biosimilar competition”. Last year, the Centers for Medicare and Medicaid (CMS) selected ten drugs covered under Part D for the first phase of negotiations for initial price applicability year 2026 and participated in negotiations with drug manufacturers for the selected drugs.  

​In the CY 2025 HOPPS Proposed Rule, CMS proposed a new reimbursement policy for diagnostic PET scans that would provide separate payment for radiopharmaceuticals that have a per-day cost of more the $630, as well as an extra payment for hospitals when they use domestically produced technetium-99m. If finalized, this new reimbursement policy would replace the existing policy in which diagnostic radiopharmaceuticals are considered supplies and packaged into the imaging procedure. It should be noted any diagnostic radiopharmaceutical with a per-day cost of less than $630 would continue to be packaged under the current policy.

​Organizations including the American Society for Radiation Oncology (ASTRO), the American College of Radiation Oncology (ACRO), the American College of Radiology (ACR), the American Society of Clinical Oncology (ASCO), and American Association of Medical Dosimetrists (AAMD), among others, came together to lobby for newly introduced legislation which proposes a new payment model for radiation therapy. This is a result of Medicare payment cuts and the indefinite delay of the Radiation Oncology Alternative Payment Model (RO Model).