Industry News, May 2025

​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. 

​CY 2026 CPT® Coding Changes – Sneak Peek 

​Stay tuned for updates and more information applying these coding changes within your practice or facility.

Radiation Oncology Coding Changes:

Scalp Cooling Coding Changes:

Remote Monitoring Coding Changes:

Endovascular Therapy Coding Changes:

CT Angiography Head & Neck and Cerebral Perfusion Coding Changes:

Percutaneous Intralaminar Lumbar Decompression Coding Changes:

Irreversible Electroporation (IRE) of Tumors Coding Change:

Lower Extremity Revascularization Coding Change:

TEVAR with Thoracic Branch Endoprosthesis (TBE) Services Coding Change:

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Bayer Launches Phase I Trial - Novel Targeted Alpha Therapy in Liver 

Bayer has announced the start of a Phase I clinical trial evaluating 225Ac-GPC3 (BAY 3547926), a novel investigational radiopharmaceutical designed to treat advanced hepatocellular carcinoma (HCC) by targeting Glypican-3 (GPC3)-expressing tumors. GPC3, a membrane-bound oncofetal protein, is present in approximately 70–75% of HCC cases, making it a promising focus for precision radionuclide therapy.

The first-in-human study (NCT06764316) will assess the safety, tolerability, and early signs of effectiveness of BAY 3547926, both as a standalone treatment and in combination regimens, in patients with advanced stages of the disease.

Hepatocellular carcinoma remains a major global health challenge, with limited effective treatment options,” said Dr. Dominik Ruettinger, Global Head of Oncology Research and Early Development at Bayer Pharmaceuticals. “The initiation of this trial represents a critical step forward in our mission to deliver innovative, targeted cancer therapies with strong efficacy and precision. Targeted alpha therapies are a key pillar in our precision oncology strategy.”

According to the Mayo Clinic, liver cancer, particularly HCC, ranks as the third leading cause of cancer-related mortality worldwide, with close to 900,000 new diagnoses each year. In the United States, it is one of the fastest-rising causes of cancer death, contributing to around 2 percent of new cancer cases and 5 percent of cancer-related fatalities. Despite ongoing advancements in cancer therapeutics, many clinicians remain unsatisfied with current treatment outcomes for HCC.
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Bayer introduced 225Ac-GPC3 to the scientific community on April 28, 2025, at the American Association for Cancer Research (AACR) Annual Meeting. Presented in the "New Drugs on the Horizon" session, the preclinical data highlighted the therapy’s favorable biodistribution profile—characterized by minimal uptake in healthy tissues and rapid clearance—as well as its ability to drive tumor shrinkage in animal models. With its targeted mechanism of action and early evidence of anti-tumor activity, 225Ac-GPC3 holds significant promise as a next-generation therapeutic option for patients battling advanced liver cancer.

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Senate Bill Introduced for Medical AI Reimbursement

Recently introduced by the U.S. Senate, the Health Tech Investment Act (Senate Bill 1399) seeks to establish a Medicare reimbursement pathway for medical devices approved by the U.S. Food & Drug Administration (FDA) that are artificial intelligence (AI) enabled. 

This bipartisan bill would amend title XVIII of the Social Security Act to ensure “appropriate payment of certain algorithm-based Healthcare Services under the Medicare program” by detailing:

• A new technology ambulatory payment classification (APC) for artificial intelligence (AI) and machine learning (ML), also known as Algorithm-Based Healthcare Services (ABHS).
• A special rule for eligible outpatient department (OPD) ABHS provided on or after January 1, 2026, to be assigned to a new technology APC, determined on cost data from the manufacturer.
• An adjustment of the application process and criteria for the new technology APC, including defined eligibility start and end times for new AI-enabled devices. The ABHS must be "distinct from but performed concurrently with, adjunctive to, or provided in any other modality or form as part of an underlying service and require additional resource."

AI’s role in healthcare is continuing to increase, particularly in radiology, where AI can assist physicians and other healthcare professionals to quickly review and interpret images to make a more timely and informed diagnosis. The majority of FDA-approved AI-enabled medical devices are used in radiology.

​The bill has drawn support from AdvMed, an imaging lobbying group which represents 50 radiology vendors, including Siemens Healthineers, Canon, and Philips. It is also endorsed by the National Health Council, Alliance for Aging Research, Brem Foundation to Defeat Breast Cancer, Focused Ultrasound Foundation, National Psoriasis Foundation, Patients Rising, and Right Scan Right Time. 

​In a recent press release, Senator Mike Rounds (R-SD), one of the co-sponsors of the bill, stated there is no current Medicare payment system for these devices. However, he goes on to say, “This legislation would create that system, improving diagnoses and encouraging the adoption of AI devices in clinical settings.”

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MACs to Begin CT-Based Colorectal Cancer Screening Coverage

The Medicare Administrative Contractors (MACs) were recently instructed to begin coverage of CT-based colorectal cancer screening CPT® code 74263. This directive was issued through a Change Request Transmittal (CR 13939), under the National Coverage Determination (NCD 210.3), Colorectal Cancer Screening Tests. Coverage of this exam is effective July 1, 2025, and all coinsurance and deductibles will be waived for beneficiaries.

The Centers for Medicare and Medicaid Services (CMS) initially proposed and finalized payment for this exam in their proposed and final rules for the fiscal year (FY) 2025 Hospital Outpatient Prospective Payment System (HOPPS). As a continued advocate for this issue, the American College of Radiology (ACR) welcomed the finalized policy and subsequent implementation. Moreover, the College encouraged their members to offer the screening exam to “all patients who can benefit from early detection of colorectal cancer. Previously, this was a non-covered service for the Medicare population that led to a lack of access for this vulnerable population.”

​Provider education coding and reimbursement information for CT-based colorectal cancer screening exams will be developed by CMS and offered through a Medicare Learning Network® (MLN) Matters® article.  

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ACR Updates Guidelines on Managing Contrast Media Reaction

​Iodinated contrast media (ICM) is commonly used for x-ray based imaging modalities, including computed tomography (CT) scans, fluoroscopy, angiography, venography, or plain radiography. The American College of Radiology (ACR) provides a Manual on Contrast Media, which includes guidance for providers in ICM administration. In the past, ACR guidance regarding ICM differed from other relevant organizations. However, in May 2025, the ACR released updated recommendations for ICM which were developed collaboratively with the American Academy of Allergy, Asthma, and Immunology (AAAAI). After the evaluation of scientific evidence, a task force of experts from both organizations developed and endorsed consensus recommendations. According to the article, entitled Management and Prevention of Hypersensitivity Reactions to Radiocontrast Media: A Consensus Statement from the American College of Radiology and the American Academy of Allergy, Asthma & Immunology, published in the Radiology journal on May 6, 2025, 

The task force took into account the strength of evidence and balanced the potential risks of recurrent reactions with those of premedication and product avoidance when making these recommendations to improve and standardize the care of patients who experience or have a history of reaction to ICM.”

​New ACR guidelines address differences in other relevant organizations with the ACR on the use of premedication for patients with a history of hypersensitivity reactions to ICM. As detailed in an article published in Health Imaging, key ACR updates include the following:

• Premedication Adjustments: For patients with a history of mild immediate ICM reactions, premedication is no longer routinely recommended. Instead, switching to a different contrast agent is advised when possible.
• Severe Reaction Protocols: Patients with prior severe reactions should, when feasible, undergo alternative imaging studies. If ICM use is necessary and the agent cannot be changed, premedication is recommended, and the procedure should occur in a hospital equipped with a rapid response team.
• Clarifications on Allergies: Premedication is not advised for individuals with a history of chemotoxic or physiologic reactions, nor for those with isolated shellfish or iodine allergies, including reactions to topical povidone-iodine.

According to Carolyn Wang, MD, with the Department of Radiology at the University of Washington in Seattle and colleagues in the Radiology journal article, “Patients labeled as having an ICM allergy in the medical record pose a multidisciplinary clinical problem requiring healthcare professionals to obtain a comprehensive history and to balance the potential risks of recurrent reactions with those of premedication and product avoidance, as appropriate.”

​These ACR guideline updates aim to align practices across all healthcare organizations and ensure patient safety during imaging procedures.  

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Blending Human Expertise with AI: The Future of Medical Coding

Artificial intelligence (AI) and machine learning (ML) are rapidly reshaping the healthcare industry—but progress comes with its own set of challenges. As these technologies become more embedded in daily operations, the demand for a more tech-savvy workforce is growing. In fact, a recent survey by the American Health Information Management Association (AHIMA) found that 75 percent of participants believe “upskilling” is necessary just to keep pace with the rapid adoption of AI and related technologies.

Healthcare leaders are now tasked with finding the right balance between advanced automation and invaluable human knowledge. Nowhere is this balancing act more important than in the profession of medical coding, where experienced professionals are vital to maintaining quality and accuracy.

Computer-assisted coding (CAC) tools powered by AI are helping to make healthcare data workflows more efficient. These systems can accelerate data processing, offer real-time code suggestions, and highlight documentation issues. But when it comes to coding, speed is only part of the equation—precision is equally, if not more, important.

Errors in medical coding don’t just cause delays, they can lead directly to denied claims, lost revenue, and regulatory trouble. That’s why even the most cutting-edge AI solutions require human oversight to ensure accuracy and compliance.

AI systems, while impressive, are only as effective as the data used to train them. Many still struggle with outdated, incomplete, or biased information, and lack the clinical judgment and contextual understanding that human coders bring to the table.

Professional coders keep up with the latest medical coding guidelines, navigate complex patient scenarios, and interpret documentation with a level of nuance that machines currently can’t match. Their role is critical in minimizing financial risk and ensuring regulatory compliance. In fact, a study by the Government Accountability Office (GAO) found that Medicare fee-for-service improper payments, which include billing errors, totaled approximately 31 billion dollars in 2020, accounting for 6.3 percent of Medicare fee-for-service payments.

​The most effective medical coding strategies combine advanced tools with the expertise of trained professionals. Coders provide a critical layer of validation, ensuring that new technologies actually enhance performance instead of introducing new complications. This collaborative model delivers the best results—not just in terms of productivity, but also long-term financial and operational outcomes. 

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