Get ready to dig into more than 400 code changes as part of the 2025 CPT code set. That includes 270 new codes, including dozens of surgical codes, as well as 112 deletions and 38 revisions.
You’ll also find numerous guideline changes within the 2025 CPT Manual, with expanded guidance for the new CPT-based virtual check-in service and online digital E/M services. The AMA released the revised CPT code set in September, while the full guidelines are now accessible as the books
are available for purchase ahead of the Jan. 1 implementation date.
Discover new codes, guidelines
While the majority of the new codes coming in 2025 appear in the Pathology and Laboratory (28%) and Category III (30%) code sections of the book, you’ll also find notable additions elsewhere.
If your practice has previously billed for virtual check-in services via code G2012, you should be prepared for a switch to the CPT code set in 2025. In place of the HCPCS code, be ready to report CPT code 98016 come Jan. 1. The new CPT code comes with the same billing rules as the outgoing HCPCS code.
The CPT book provides billing guidance within the 2025 manual that aligns with prior G2012 reporting requirements: “Code 98016 is reported for established patients only. The service is patient-initiated and intended to evaluate whether a more extensive visit type is required (eg, an office or other outpatient E/M service [99212, 99213, 99214, 99215]). Video technology is not required. Code 98016 describes a service of shorter duration than the audio-only services and has other restrictions that are related to the intended use as a ‘virtual check-in’ or triage to determine if another E/M service is necessary.”
Also note a time-based rule for the virtual check-in: “When the patient-initiated check-in leads to an E/M service on the same calendar date, and when time is used to select the level of that E/M service, the time from 98016 may be added to the time of the E/M service for total time on the date of the encounter,” the CPT book states.
Telemedicine arrives, payment does not
When you open up your 2025 edition, you’ll find a multi-page section covering “telemedicine services.” The telemedicine code family includes “synchronous audio-video” (98000-98007) and “synchronous audio-only” (98008-98015) E/M services. The section includes a table on medical decision-making and time-based rules for reporting, and both sets of codes can be reported based on medical decision-making (MDM) or time.
However, remember: Under CMS’ proposed policy, the agency will not cover this suite of services in 2025. “We do not believe there is a programmatic need to recognize the audio/video and audio-only telemedicine E/M codes for payment under Medicare,” CMS stated in the
proposed 2025 Medicare physician fee schedule.
Read the descriptor, the whole descriptor and nothing but the descriptor
For the second year in a row the CPT Manual revised its instructions for use of the CPT codebook in the manual’s introduction. The update emphasizes that coders must read the entire descriptor. According to the CPT Manual, “all the language within a code descriptor should be assessed when selecting the appropriate procedure or service.” That includes text in descriptor’s parentheses.
A common example would be language that indicates the procedure is an add-on code, and cannot be reported without the appropriate primary code, such as “Ablation of 1 or more thyroid nodule(s), additional lobe, percutaneous, including imaging guidance, radiofrequency (List separately in addition to code for primary procedure)” the descriptor for new code 60661.
The descriptor for new code 49186 contains parentheses that give guidance on the type of procedures described by the code and informs the coder that it should be reported once when the provider addresses one or more structures. “Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less,” reads the descriptor for new code.
Find additional E/M guideline updates
You’ll find fresh guidance within the “preventive services” E/M section of the book. “Immunization/vaccine/toxoid products, immunization administrations, ancillary studies involving laboratory, radiology, other procedures, or screening tests (eg, vision, hearing, developmental) identified with a specific CPT code are reported separately,” the AMA reminds you.
The 2025 edition also adds guidance to the online digital E/M services section, covering codes 99421-99423. “If within seven days of the initiation of an online digital E/M service, a separately reported E/M visit occurs, then the physician or other QHP work devoted to the online digital E/M service is incorporated into the separately reported E/M visit,” the book states. “This includes E/M services that are provided through synchronous telemedicine visits using interactive audio and video telecommunication equipment.”
Say good-bye to telephone codes
As part of the latest E/M update, the time based codes 99441-99443 will be deleted.
Note CMC suspension arthroplasty changes
When carpometacarpal (CMC) suspension arthroplasty is done using an interpositional tendon transfer, starting in 2025, you should no longer report the two codes 25447 and 26480. Instead, use a new CPT code that effectively combines both of those codes:
- 25448 (Arthroplasty, intercarpal or carpometacarpal joints; suspension, including transfer or transplant of tendon, with interposition, when performed).
Also make note of these coding parenthetical notes for code 25448 in CPT 2025:
- (Do not report 25448 in conjunction with 25447), and
- (Do not report 25448 in conjunction with 25310, 26480, when performed for intercarpal or carpometacarpal joint arthroplasty)
As part of that change, the description for code 25447 has been revised to read: “Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon).” The following coding guidelines have been added for code 25447:
- (Do not report 25447 in conjunction with 25448), and
- (Do not report 25447 in conjunction with 25310, 26480, when performed for intercarpal or carpometacarpal joint arthroplasty)
The CPT Editorial Panel approved the new combined code in May 2023 at the request of the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The RUC noted that codes 25447 and 26480 were billed together a high percentage of the time, so requested a code bundling solution.
As part of the change, code 25447 was revised to clarify that the code includes only interposition of a tendon and not suspension. CMS first revealed the changes in the 2025 Medicare physician fee schedule.
Prepare for new plane blocks that will land in 2025
Anesthesiologists will have six new plane blocks they can report in 2025 and CMS plans to cover the codes. During a plane block the provider fills the area between two fascial planes with an analgesic which bathes all of the nerves in the area. A nerve block, such as a femoral block (64447-64448) targets specific nerves. Plane blocks are typically performed to provide post-operative pain relief. The new code set will introduce four new services for the thoracic region and two for the legs and feet:
- 64466 (Thoracic fascial plane block, unilateral; by injection[s], including imaging guidance, when performed).
- 64467 ( … ; by continuous infusion[s], including imaging guidance, when performed).
- 64468 (Thoracic fascial plane block, bilateral; by injection[s], including imaging guidance, when performed).
- 64469 ( … ; by continuous infusion[s], including imaging guidance, when performed).
- 64473 (Lower extremity fascial plane block, unilateral; by injection[s], including imaging guidance, when performed).
- 64474 ( … ; by continuous infusion[s], including imaging guidance, when performed).
Look for a T code to become permanent.
There’s good news for eye doctors who perform insertion of iris prosthesis in the new CPT manual. Temporary code 0616T (Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens) will be deleted and replaced with permanent code 66683 (Implantation of iris prosthesis, including suture fixation and repair or removal of iris, when performed). The T code is carrier-priced, but CMS will cover the permanent code, according to the proposed rule.
Stay tuned to coming issues of Part B News for additional coverage of the 2025 CPT code and guideline updates.
Editor’s note: Don’t miss a chance to ask skilled billers, coders and compliance professionals about these changes and earn CEUs without the hassle and expense of travel. Register now for the
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