2026 CPT coding updates

By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, Senior Manager, Coding and Reimbursement, January 1, 2026

Academy coding staff address important coding topics each month in DermWorld Coding Consult. Read more Derm Coding Consult articles.

The Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) have announced the 2026 updates to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). These updates took effect on Oct. 1, 2025, and will apply to patient encounters through Sept. 30, 2026. The 2026 update includes 487 new diagnosis codes, 38 revised codes, and 28 deletions.

The American Medical Association (AMA) has released the Current Procedural Terminology (CPT®) coding updates that will went into effect on Jan. 1, 2026. The code set includes 288 new codes, a few that are specific to dermatology, designating the latest advances in medical, surgical, and diagnostic services available to patients.

Acne surgery

The code descriptor for acne surgery has been revised to improve accuracy in reporting. The term “acne surgery” has been replaced with “extraction” to better reflect the technique used. Both the AMA and the AADA have indicated that this change was made to reduce confusion and provide clarity, noting that the procedure uses the “extraction” technique of all lesions listed in the code descriptor, including milia. There are no other changes that will impact the provision or reporting of this procedure. The code descriptor has been revised to:

10040: Extraction (e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)

Radiation therapy treatment

In October 2023, the AMA’s RUC Relativity Assessment Workgroup (RAW) reviewed Category III code 0394T and determined it was being reported at high volume, with over 1,000 Medicare services in 2021. As a result, four new category I codes (77436, 77437, 77438, and add-on code 77439) were created to report surface radiation therapy, replacing 0394T. Code 0394T and its parenthetical notes have been deleted, and a new parenthetical note now directs users to the new category I codes. These changes were made to ensure more accurate reporting as the number of patients receiving surface radiation therapy continues to grow.

Electronic brachytherapy - Cat III code 0394T has been deleted

Clinical brachytherapy requires the use of either natural or man-made radioelements applied into or around a treatment field of interest. The supervision of radioelements and dose interpretation are performed solely by the therapeutic radiologist.

Until 2025, dermatologists were reporting high-dose-rate electronic brachytherapy with category III code 0394T, High dose rate electronic brachytherapy, skin surface application, per fraction, which includes basic dosimetry when performed. This code has now been deleted. Beginning in 2026 and beyond, high-dose-rate electronic brachytherapy will be reported with category III code 0395T High dose rate electronic brachytherapy, interstitial or intracavitary treatment, per fraction, includes basic dosimetry, when performed.

In addition, two new codes, 77437 and 77438, for different energy levels of treatment, have been created. 77437 is intended to report less than 150 kV energy, called superficial delivery, and code 77438 is intended to report for greater than 100 kV for energy levels called orthovoltage delivery.

Surface radiation therapy

‘CPT code 77401, Radiation treatment delivery, superficial and/or ortho voltage, per day’ and its associated parenthetical notes and references have been deleted. To report the delivery of superficial radiation, CPT has created new codes 77436 and 77439 and changed the code descriptor as well as allowing the reporting of the use of image guidance to be reported, when performed with the add-on code.

In addition, a new heading titled “Surface Radiation Therapy” (SRT) with new guidelines has been established in the radiology section, and new parenthetical notes following the codes have been established.

The AMA CPT guidelines describe SRT as a form of external radiation therapy that uses low-energy radiation (<500 kilovoltage [kV]) designed to limit penetration beyond the skin. Because the majority of the radiation dose is delivered at the surface, SRT is commonly used in the treatment of skin cancers.

The guidelines further state that while X-rays can be generated at varying energy levels, low-energy X-rays are preferred for these cases because they do not penetrate deeply into the body and instead concentrate their effect on the skin. These low-energy X-rays are often referred to as superficial (SXT) or orthovoltage (DXT) X-rays. Both superficial and orthovoltage radiotherapy rely on low-energy ionizing radiation to effectively treat cancers and other conditions located on or near the skin surface.

SRT uses low-energy X-rays at or below 150 kV to treat a range of benign and malignant skin lesions located on or close to the surface of the skin. These X-rays generally penetrate to a depth of less than 1.5 to 2 cm from the skin surface. The equipment and shielding requirements for delivering superficial radiation differ from those required for orthovoltage radiation.

Orthovoltage X-rays, sometimes referred to as deep X-rays (DXR), operate at energies between >150 and 500 kV. They represent the upper limit of energies used in surface radiation therapy and are capable of penetrating tissue to a therapeutic depth of up to 4 cm, making them appropriate for treating certain cancers and tumors that extend slightly deeper beneath the skin.

Superficial or orthovoltage ultrasound image guidance, when used to place radiation therapy fields for the treatment of cutaneous tumors, may be reported only once per course of treatment.

77436: Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting (Do not report 77X05 in conjunction with 77261, 77262, 77280)
77437: superficial, delivery, ≤150 kV, per fraction (e.g., electronic brachytherapy)
77438: orthovoltage, delivery, >150-500 kV, per fraction
77439: superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous tumors, per course of treatment
(List separately in addition to code for primary procedure)

(Use 77439 in conjunction with 77437, 77438) (Do not report 77436, 77437, 77438, 77439 in conjunction with 77261, 77262, 77263, 77280, 77285, 77290, 77295, 77300, 77306, 77307, 77316, 77317, 77318, 77331, 77332, 77333, 77334, 77387, 77402, 77407, 77412, 77427, 77431, 77432, 77435, 77469, 77470, 77499, 77600, 77605, 77610, 77615, 77620, 77761, 77262, 77263, 77767, 77768, 77770, 77771, 77772, 77778, 77789)
(For high-energy treatment of skin cancer [e.g., electrons, photons, gamma rays], see 77402, 77407, 77412)
(For high-dose rate radionuclide surface brachytherapy, see 77767, 77768)

Beware of coding limitations

AMA coding guidelines further state that SRT should not be reported in conjunction with megavoltage (MeV) (77402, 77407, 77412). Do not report clinical treatment planning (77261, 77262, 77263), simulation (77280, 77285, 77290, 77295), basic dosimetry calculation (77300), special dosimetry (77331), treatment devices (77332, 77333, 77334), isodose planning (77306, 77307, 77316, 77317, 77318), or radiation treatment management (77427, 77431, 77432, 77435, 77469, 77470, 77499) in conjunction with 77X05, 77X07, 77X08, 77X09.

Visit the AMA website for more information on the 2026 CPT coding updates.

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