Reinforce your coding and billing efforts in 2027: Prepare to welcome nearly 300 new CPT codes across a wide range of services and body systems taking effect Jan. 1. The AMA’s CY 2027 CPT update also contains 74 revised codes and 80 deletions.
Many of the deleted codes are being replaced with new codes. See the body system round-ups below for further guidance. The CPT update also features a definition for prescription drug management in the level-based E/M services section and more guidance for chronic care management coding.
Level-based, chronic care E/M guidelines expand
You’ll find new guidance for level-based E/M and chronic care management in your 2027 CPT manual, including long-awaited help with prescription drug management.
The 2027 manual adds a detailed definition for prescription drug management to the Risk of the Complications and/or Morbidity or Mortality of Patient Management (risk) section of the medical decision-making (MDM) guidelines.
Prescription drug management is listed as an example of moderate risk in the MDM chart, but the new CPT definition makes it clear that it can be high risk. “The level of risk is determined by the patient's clinical factors and the medication’s potential for harm, including the need for counseling, interaction assessment, dose adjustment, or monitoring,” according to the definition. Over-the-counter medications can be moderate or high risk, and managing several medications at the same time can be high risk, the new definition explains.
Other changes to the MDM section include a revamped definition in the Number and Complexity of Problems Addressed at the Encounter category. The 2027 manual removes the word “severe” from the current description that begins “Chronic illness with severe exacerbation, progression, or side effects of treatment.” The 2027 manual adds a more detailed explanation of the patient’s condition and practitioner’s treatment goals.
You’ll also find updates in the care management services section of the E/M chapter, including details that expand on the definition of clinical staff and explain what “directed by” means in regard to the supervising physician or qualified health care professional.
For example, the definition of "clinical staff" reads: "For the purposes of care management, 'clinical staff ' refers to members of the care team, under the direction of a physician or other QHP, who provide clinical support (see care management activities) to the patient receiving care management. The care team member must be qualified to perform the work assigned to them by education, training, and, when applicable, licensure/regulation."
Temporary to permanent transitions
Look for procedures that made the transition from the list of temporary Category III codes to the chapters for permanent codes in this year’s update. You’ll find permanent cardiac contractility modulation (CCM) system procedure codes such as 0408T-0416T transitioned to permanent codes 33290-33297 and 33307-33309, and transcatheter tricuspid valve replacement (TTVR) procedures will switch from 0569T and 0646T to 33466 and 33469.
CMS intends to cover these codes, according to the proposed 2027 Medicare physician fee schedule.
Integumentary system surgery
Four new skin cell suspension autograft (SCSA) codes will replace the eight existing SCSA codes 150011-15018. Each of the new codes encompass the three steps of SCSA procedures, including harvest of epidermal and dermal skin, enzymatic processing of the harvested skin cells and spray-on application to the wound site, with fixation and dressing, according to new guidance added in the 2027 CPT manual.
SCSA is used for treatment of conditions such as thermal burns, traumatic avulsion such as degloving injuries and surgical excision of necrotizing tissue. The new codes include:
- 15006 (Skin cell suspension autograft [SCSA], trunk, arms, and/or legs; first 100 sq cm or less, or 1% of body area of infants and children).
- +15007 ( … ; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof [List separately in addition to code for primary procedure]).
- 15008 (Skin cell suspension autograft [SCSA], face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children).
- +15009 ( … ; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof [List separately in addition to code for primary procedure]).
Musculoskeletal surgery
Intermediate joint arthrocentesis codes 20605 and 20606 have been revised to clarify additional joints the codes apply to:
- 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa [eg, temporomandibular, acromioclavicular, wrist, including carpometacarpal (CMC), elbow,
or ankle, including tarsometatarsal (TMT), olecranon bursa]; without ultrasound guidance).
- 20606 ( … ; with ultrasound guidance, with permanent recording and reporting).
A parenthetical note has been added at the end of the Grafts (or Implants) section, stating: “For bone marrow harvesting for therapeutic musculoskeletal treatment, excluding spine surgery, use [Category III code] 1095T.”
Add-on code 20985 has been revised to allow reporting regardless of whether imaging is used:
- +20985 (Computer-assisted surgical navigational procedure for musculoskeletal procedures
, image-less [List separately in addition to code for primary procedure]).
Two new codes are added for surgical placement of intraosseous fiducial markers to be used for future therapeutic interventions such as radiation therapy. These are meant to be stand-alone procedures, not add-ons to a bone biopsy procedure, according to new guidance in the manual. To report a separate and distinct bone biopsy, refer to codes 20220 and 20225, the manual states.
- 20988 (Placement of localization marker[s] [eg, fiducial marker(s)], intraosseous, percutaneous, including imaging guidance, when performed; first target site).
- +20989 ( … ; each additional target site [List separately in addition to code for primary procedure]).
A new add-on code reports cryoablation for bone tumors:
- +20994 (Ablation therapy for reduction or eradication of bone tumor, including adjacent soft tissue when involved by tumor extension, cryoablation, open [List separately in addition to code for primary procedure]).
Code 20994 is to be used in conjunction with the following primary codes, according to CPT: 21601, 21602, 21603, 22100, 22101, 22102, 22110, 22112, 22114, 23140, 23145, 23146, 23150, 23155, 23156, 24110, 24115, 24116, 24120, 24125, 24126, 25120, 25125, 25126, 25130, 25135, 25136, 26200, 26205, 26210, 26215, 27065, 27066, 27067, 27355, 27356, 27357, 27635, 27637, 27638, 28100, 28102, 28103, 28104, 28106, 28107 and 28108.
A new guidance paragraph added to the spinal Osteotomy section instructs that “Codes 22210, 22212, 22214 and 22216 include complete resection of the interspinous ligament and the entirety of the ligamentum flavum (ie, laminar and subarticular) to allow deformity correction through spinal column realignment. The osteotomy includes resection of the inferior portion of the lamina, the inferior facet of the cranial vertebra, the superior portion of the lamina, and superior facet of the caudal vertebra.”
Under the codes, new parenthetical notes instruct that codes 22210, 22212, 22214 and 22216 should not be reported at the same level as Nervous System section codes 63001-63053, among other points.
Look for more revisions to the two percutaneous sacroiliac joint fusion codes:
- 27278 (Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, including imaging
with image guidance, includes obtaining bone graft when performed, unilateral; placement of intra-articular structural bone graft, metal and/or synthetic device[s] without cortical piercing, including use of osteopromotive material and/or obtaining bone graft, when performed device(s), without cortical piercing).
- 27279 ( … ; placement of transarticular
device(s) and/or intra-articular device[s] piercing the lateral or medial cortices of the ilium and the lateral cortex of the sacrum that engage bone with intrinsic fixation [eg, screw(s), flange(s), blade(s)] piercing the lateral cortex of the sacrum and the medial cortex of the ilium [with or without piercing the lateral cortex of the ilium], including use of osteopromotive material and/or obtaining bone graft, when performed).
New Category I CPT code 27417 describes open placement of acellular scaffold(s) (e.g., aragonite) implant(s) for osteochondral lesion(s) in the knee.
Previously, surgeons reported Category III code 0737T for this procedure. CPT is retaining code 0737T to allow reporting of the implants in locations other than the knee.
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