HCPCS & CPT Code Updates for 2025: What Specialty Practices Must Know

Every year, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) release critical updates to HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes. These updates affect how providers report services, how much they’re reimbursed, and how compliant their billing practices remain. In 2025, the stakes are even higher as healthcare continues to shift toward value-based care, digital health, and procedure-specific reimbursement models.

Whether you’re in cardiology, orthopedics, behavioral health, or another specialty, staying current with 2025’s HCPCS and CPT changes is essential for protecting your revenue cycle and avoiding audit risks.

In this blog, we’ll walk you through the most significant 2025 coding updates, what they mean for specialty practices, and how to proactively prepare your team and systems for compliance and accuracy.

Understanding the Basics: HCPCS vs. CPT

Before we dive into the 2025 changes, let’s briefly clarify the difference between CPT and HCPCS codes:

CPT codes (maintained by AMA): Used to describe medical, surgical, and diagnostic procedures. Most are numeric (e.g., 99213 for an established office visit).
HCPCS codes (managed by CMS): Include CPT codes as Level I, but also include Level II codes (alphanumeric, e.g., G2025, J3490) for non-physician services, supplies, DME (durable medical equipment), and medications.

Note: While all CPT codes are HCPCS Level I codes, not all HCPCS codes are CPT codes.

What’s New in 2025: Key Highlights

As of January 1, 2025, both the CPT and HCPCS manuals include hundreds of additions, revisions, and deletions. Here’s a summary of the major changes specialty providers need to know:

🩺 1. E/M Services: Continued Refinement

CPT codes 99202–99215 (office/outpatient evaluation and management) remain unchanged in structure, but CMS has updated documentation guidelines to emphasize medical decision-making (MDM) over time for most specialties.

What You Need to Know:

Documentation must clearly reflect complexity of care, not just length of time.
Practices should audit 99214 and 99215 usage to ensure accuracy and avoid overbilling.
Split/shared visit documentation is under tighter scrutiny in facility settings.

💉 2. Remote Monitoring & Digital Health

With the ongoing rise of virtual care, new CPT and HCPCS codes now support expanded reimbursement for:

Remote therapeutic monitoring (RTM)
Chronic condition management
Digital cognitive assessments

New for 2025:

CPT 98982: Remote therapeutic monitoring for speech-language pathologists
G3024–G3026: New HCPCS codes for hybrid virtual/in-person chronic care management (CCM)
Additional modifiers for hybrid care coordination models

Tip: If you offer RPM, RTM, or CCM services, make sure your billing software includes these 2025 updates.

🧠 3. Behavioral Health Coding Updates

CMS is continuing its push to expand mental health access, especially via telehealth.

Key Changes:

G0323: Ongoing reimbursement for audio-only psychotherapy under Medicare
New CPT codes for brief crisis interventions in outpatient settings
Expansion of licensed counselor eligibility under certain codes

Impact:

Behavioral health practices can now bill more flexibly using audio-only and digital therapy platforms, especially in rural or underserved areas.

🦴 4. Orthopedics & Musculoskeletal Coding

Orthopedic procedures saw several code revisions and descriptor changes to align with clinical best practices and imaging innovations.

Highlights:

Updates to arthrodesis and spine injection codes
Deletions of outdated joint procedure codes now replaced with more specific CPT descriptors
Revised bundling guidance for intraoperative imaging (fluoroscopy)

Recommendation: Orthopedic and pain management clinics should retrain coding staff on new bundling rules and check for modifier 59 misuse.

💗 5. Cardiology: New Ablation and Mapping Codes

Cardiology continues to evolve with technology. CPT 2025 includes:

New EP ablation codes for hybrid surgical-catheter ablations
Expanded descriptors for intracardiac echocardiography (ICE) guidance
Bundled codes for atrial mapping with ablation

Action Steps:

Cardiologists should review intraoperative bundling impacts on revenue.
Coders must use updated procedure notes to support the correct code selection.

💊 6. Injectable & Infusion Medications (HCPCS Level II)

Dozens of new J-codes and Q-codes were introduced to reflect new biologics, specialty drugs, and biosimilars approved in late 2024.

Examples include:

J2999: New immunotherapy injectable
Q5253–Q5257: New biosimilars for oncology and rheumatology
Temporary “C” codes for hospital outpatient billing

Important: Always verify the correct code and ASP pricing on CMS quarterly updates, especially for infusion and oncology providers.

🧾 7. Deleted CPT/HCPCS Codes to Watch For

Notable Deletions:

Legacy codes for outdated procedures (especially in radiology and general surgery)
Older telehealth and virtual check-in codes replaced by streamlined alternatives
Deletion of certain transitional care codes now bundled into CCM services

Risk:

Using deleted codes in 2025 can lead to claim denials, delays, and audits. Ensure your EHR templates and billing software are fully updated.

Preparing Your Practice for 2025 Code Changes

Here’s how your specialty practice can adapt quickly and accurately:

✅ 1. Conduct Internal Coding Audits

Focus on high-volume codes (E/M, procedures, infusions)
Audit 10–20 charts per provider to catch patterns of under/overcoding

✅ 2. Train Your Coding and Billing Teams

Host 2025 CPT/HCPCS update sessions for billing and clinical staff
Use specialty-specific cheat sheets and crosswalks for new codes

✅ 3. Update Your EHR and PM Systems

Ensure coding libraries are updated by your EHR vendor
Add alerts for deleted codes and new modifier rules

✅ 4. Verify Payer-Specific Code Policies

Some commercial payers may delay adoption of newer codes
Others may require prior authorizations for new services

✅ 5. Outsource Complex Coding When Necessary

For specialties like cardiology, orthopedics, and behavioral health, consider outsourcing to certified coders who stay current with changes and payer nuances.

Final Thoughts

Each year’s coding updates bring more than just numbers—they bring significant financial and compliance implications. Failing to adapt to CPT and HCPCS changes can result in lost revenue, denied claims, and regulatory scrutiny. On the other hand, practices that stay ahead of the curve can optimize reimbursement, avoid costly mistakes, and ensure accurate care representation.

At Right Medical Billing, we work closely with specialty providers to decode and implement annual code changes. From CPT updates to HCPCS transitions, we handle everything—from staff training to denial prevention—so you stay compliant and profitable.