CPT 2025 Code Updates: Complete Breakdown for CPC Exam Success
Table of Contents
- Introduction: 2025 CPT Overview
- CPT 2025 By The Numbers
- New Telemedicine E/M Codes (98000-98015)
- Skin Cell Suspension Autografts (15011-15018)
- MRI Safety Codes (76014-76019)
- Category III AI Taxonomy Codes
- Other Significant Updates
- Medicare Payment Considerations
- Impact on CPC Exam & Study Strategies
- Resources & References
Introduction: Why CPT 2025 Updates Matter for CPC Candidates
The CPT (Current Procedural Terminology) code set, often described as "the language of medicine," undergoes annual updates to keep pace with advances in medical technology, emerging treatments, and evolving healthcare delivery models. For the 2025 edition, the American Medical Association (AMA) introduced 420 total updates—one of the most significant revision cycles in recent years.
As a CPC exam candidate, understanding these updates is crucial for two reasons: First, your exam will test knowledge of the current CPT code set (2025 codes effective January 1, 2025). Second, these updates reflect real-world practice changes you'll encounter as a professional coder.
🎯 What Makes 2025 Updates Special
The CPT 2025 updates represent a major shift in how healthcare services are coded, particularly in three groundbreaking areas:
- Telemedicine Services: First dedicated code family (98000-98016) replacing modifier-based reporting
- AI-Powered Medicine: Expanded AI Taxonomy with new Category III codes for machine-learning diagnostics
- Advanced Wound Care: Novel skin cell suspension autograft technology for burn and trauma treatment
CPT 2025 By The Numbers
| Update Type | Count | Percentage of Changes |
|---|---|---|
| New Codes | 270 | 64.3% |
| Deleted Codes | 112 | 26.7% |
| Revised Codes | 38 | 9.0% |
| Total Updates | 420 | 100% |
Updates by Category
- Proprietary Laboratory Analyses: 37% of new codes (100 codes)—mostly genetic testing
- Category III Codes: 30% of new codes (81 codes)—emerging technologies
- Evaluation & Management: 17 new telemedicine codes
- Surgery (Integumentary): 8 new skin cell suspension autograft codes
- Radiology: 6 new MRI safety codes
- Surgery (General): 5 new abdominal tumor resection codes
New Telemedicine E/M Codes (98000-98015): Game-Changer or Payer Confusion?
The most visible change in CPT 2025 is the creation of a dedicated Telemedicine Services subsection within the Evaluation and Management section. This marks the first time telemedicine has its own code family rather than relying on modifiers appended to traditional office visit codes.
The Evolution of Telemedicine Coding
Pre-2025 (Pandemic Guidelines)
Telemedicine services were reported using standard office visit codes (99202-99215) with modifiers:
- Modifier 95: Synchronous audio-video telemedicine
- Modifier 93: Audio-only telecommunications (added during pandemic)
- Modifier GT: Medicare's telemedicine identifier
2025 Forward (New CPT Structure)
Dedicated telemedicine codes that parallel office visit structure:
- 98000-98007: Synchronous audio-video E/M services
- 98008-98015: Synchronous audio-only E/M services
- 98016: Brief communication technology service (5-10 minutes)
Complete Code List: Synchronous Audio-Video Services
Complete Code List: Synchronous Audio-Only Services
Key Guidelines for Telemedicine Codes
- Real-time, interactive encounters required: Both provider and patient must be present simultaneously. Pre-recorded videos or asynchronous communication doesn't qualify.
- Code selection based on MDM or time: Like office visits, you can choose level based on Medical Decision Making complexity OR total time on date of encounter.
- Audio-only minimum time: Audio-only codes (98008-98015) require MORE than 10 minutes of medical discussion. Services 5-10 minutes use 98016 instead.
- No same-day in-person E/M: Cannot report telemedicine codes on same date as in-person E/M service.
- Connection time doesn't count: Time spent establishing audio/video connection, scheduling, or technical troubleshooting is excluded from total time.
- Video loss during encounter: If video connection lost mid-visit, report the code that represents majority of the service (audio-video vs. audio-only).
⚠️ Critical Medicare Exception
Medicare DOES NOT recognize CPT codes 98000-98015. This is arguably the most important fact about these new codes.
For Medicare patients, providers must continue using:
- Standard office visit codes (99202-99215)
- Modifier 95 for audio-video services
- Modifier 93 for audio-only services (when video unavailable/declined)
CMS (Centers for Medicare & Medicaid Services) declined to adopt these codes, citing statutory limitations under the Social Security Act. This creates a two-tier system where commercial payers may or may not accept the new codes.
What Replaced: Deleted Telephone Codes
The new telemedicine codes replaced the previous telephone E/M codes:
- 99441: Deleted (5-10 minutes telephone E/M)
- 99442: Deleted (11-20 minutes telephone E/M)
- 99443: Deleted (21-30 minutes telephone E/M)
These deletions necessitated the creation of the new audio-only code range (98008-98015) to maintain telehealth billing options.
CPC Exam Implications
✅ What CPC Candidates Must Know
- Code structure: Understand parallel organization to office visit codes (new vs. established, four complexity levels)
- Time thresholds: Memorize minimum times for each level (different for new vs. established)
- Audio-only requirements: >10 minutes of medical discussion OR use 98016 for 5-10 minutes
- Coding guidelines: Know when to report by MDM vs. time (same rules as 2023 office visit changes)
- Medicare alternative: Be aware these codes aren't Medicare-accepted (but know them anyway for exam)
Skin Cell Suspension Autografts (15011-15018): Revolutionary Burn Care
One of the most clinically significant additions to CPT 2025 is a new subsection for Skin Cell Suspension Autograft (SCSA) procedures. This cutting-edge technology represents a major advancement in treating severe burns, degloving injuries, and traumatic wounds.
What is SCSA Technology?
Skin cell suspension autografting is a novel technique where:
- A small sample of patient's healthy skin is harvested (as small as 1 cm²)
- The skin is processed through enzymatic and mechanical disaggregation to isolate individual cells
- Cells are suspended in a solution and sprayed onto the wound
- The cells regenerate to cover a much larger area (1:80 expansion ratio)
SCSA vs. Traditional Skin Grafts
| Feature | Traditional STSG | SCSA |
|---|---|---|
| Expansion Ratio | 1:2 (meshed) | 1:80 |
| Harvest Depth | 0.008-0.012 inches | 0.006-0.008 inches |
| Application Method | Placed and sutured/stapled | Sprayed onto wound |
| Processing Location | None (direct application) | Point-of-care in OR |
| Scarring | More visible mesh pattern | Reduced scarring |
| Donor Site Morbidity | Higher (larger harvest) | Lower (minimal harvest) |
The Eight New SCSA Codes Explained
Harvesting Codes (15011-15012)
What's included: Harvesting epidermal and dermal skin layers for use in autograft. Code selection based on surface area of skin harvested.
Coding tip: "Part thereof" means any portion—if 26 sq cm harvested, report both 15011 and 15012.
Preparation Codes (15013-15014)
What's included: The laboratory work of creating the cell suspension through enzymatic processing, manual mechanical disaggregation of skin cells, and filtration.
Critical note: These codes require MANUAL processing. If automated processing equipment is used, report an unlisted code instead (facility may report HCPCS C8002 for automated preparation).
Application Codes (15015-15018)
What's included: Spray application of SCSA to wound and donor sites, including application of primary dressing with fixation (sutures, staples, or surgical glue).
Body area differentiation: Codes differ by anatomic complexity—face/hands/feet/genitalia use 15017/+15018, all other areas use 15015/+15016.
Separately Reportable Services
The following procedures ARE reported separately when performed with SCSA:
- Surgical preparation of recipient site: Excision of burn eschar, wound debridement (15002-15005)
- Additional autografts: Split-thickness or full-thickness skin grafts placed BEFORE SCSA application (15040-15261)
- Donor site repair: Repair of harvest site requiring skin graft or local flaps
Not separately reported: Primary dressing, fixation methods, donor site care not requiring grafts.
Coding Example
Clinical Scenario: Patient with 30% TBSA full-thickness burns to chest and abdomen. Surgeon harvests 40 sq cm of healthy skin from thigh, prepares SCSA using manual processing, and applies suspension to 800 sq cm burn area on trunk.
Correct Codes:
- 15011 - Harvest first 25 sq cm
- 15012 - Harvest additional 15 sq cm
- 15013 - Preparation first 25 sq cm
- 15014 - Preparation additional 15 sq cm
- 15015 - Application to trunk first 480 sq cm
- 15016 - Application additional 320 sq cm
Additional code if performed: 15002/15003 for surgical preparation/excision of burn eschar (reported separately)
CPC Exam Considerations
✅ Key Points to Memorize
- Code family: 15011-15018 (8 codes total in new SCSA subsection)
- Three-phase process: Harvest (15011-15012) → Prepare (15013-15014) → Apply (15015-15018)
- Surface area measurements: 25 sq cm for harvest/preparation, 480 sq cm for application
- Anatomic distinction: Application codes differ by body region complexity
- "Part thereof" rule: Any portion of additional area qualifies for add-on code
- Manual vs. automated: Codes require manual processing; automated is unlisted
MRI Safety Codes (76014-76019): Addressing Device Compatibility
Six new CPT codes (76014-76019) address a growing clinical challenge: safely performing MRI exams on patients with implanted medical devices or foreign bodies. With increasing prevalence of pacemakers, neurostimulators, cochlear implants, and other devices, these codes capture the additional work required for safe MRI imaging.
Why These Codes Were Created
MRI's powerful magnetic fields pose unique risks for patients with implants:
- Device malfunction: Cardiac devices may be damaged or have settings altered
- Tissue heating: Radiofrequency energy can cause burns at implant sites
- Device displacement: Ferromagnetic materials may move or rotate in strong magnetic fields
- Image artifacts: Implants may create distortion requiring protocol customization
Previously, the extensive safety work (researching device specifications, contacting manufacturers, customizing protocols) wasn't separately reimbursable. The 2025 codes address this gap.
The Six MRI Safety Codes
Pre-Exam Assessment Codes (76014-76016)
Day-of-Exam Service Codes (76017-76019)
Time-Based Coding Rules
Codes 76014 and 76015 are time-based:
- 76014 can be reported when at least 8 minutes completed (midpoint of 15 minutes)
- 76015 requires minimum 16 additional minutes after first 15 minutes
- 76015 reported in 30-minute units (can report up to 3 times: 76014, 76015, 76015, 76015)
- Exact time must be documented in medical record
Codes 76017, 76018, 76019 are NOT time-based—report based on work performed, regardless of time spent.
When Are These Codes Used?
MRI safety codes are NOT routine for every patient with an implant. Report only when:
- Implant/foreign body poses potential risk during MRI
- Additional safety measures beyond standard screening required
- Device lacks MR conditional labeling OR is contraindicated
- Protocol customization necessary due to device constraints
- Device requires reprogramming or special positioning
Documentation Requirements
Each code requires written documentation, typically including:
- For 76014/76015: Time spent, implant identification, manufacturer specs, MR conditional status, patient instructions provided
- For 76016: Risk/benefit analysis, alternative imaging considered, specific MR parameters determined
- For 76017: Protocol modifications made, safety concerns addressed, physicist recommendations
- For 76018: Device settings before/after programming, interrogation findings
- For 76019: Positioning/immobilization method, manufacturer guidelines followed
Coding Example
Clinical Scenario: 68-year-old with deep brain stimulator (DBS) for Parkinson's requires brain MRI for new neurological symptoms. MR technologist spends 45 minutes researching DBS model, contacting manufacturer, verifying conditional status. Radiologist reviews DBS specifications and determines custom protocol needed. Medical physicist customizes scan parameters. Device representative programs DBS into MR-safe mode before scan.
Correct Codes:
- 76014 - Assessment (first 15 minutes)
- 76015 - Assessment (additional 30 minutes)
- 76016 - Radiologist safety determination
- 76017 - Medical physics exam customization
- 76018 - DBS programming into MR-safe mode
- PLUS standard MRI brain code (70551-70553)
CPC Exam Implications
✅ Study Focus Points
- Code range: 76014-76019 (6 codes in Radiology section)
- Time-based vs. non-time-based: Know which codes have time thresholds
- Add-on code limits: 76015 can only be reported 3 times maximum
- Professional vs. technical components: 76014/76015 are TC-only; others have PC
- Documentation requirements: All codes require written report
- Not routine: Only report when additional safety work needed beyond standard screening
Category III AI Taxonomy Codes: Machine Learning Meets Medicine
Artificial Intelligence (AI) and machine learning are rapidly transforming medical diagnostics and treatment planning. CPT 2025 expands the AI Taxonomy (introduced in 2023) with seven new Category III codes for AI-augmented diagnostic services.
Understanding the CPT AI Taxonomy
The AI Taxonomy classifies AI medical services into three categories based on the level of machine autonomy:
Three Categories of AI in Medicine
-
Assistive AI: Machine detects clinically relevant data without analysis
- Example: CAD system highlights suspicious areas on mammogram
- Physician performs all interpretation
-
Augmentative AI: Machine analyzes and quantifies data to yield clinically meaningful output
- Example: AI calculates ejection fraction from echocardiogram
- Physician interprets AI-generated measurements
-
Autonomous AI (3 levels): Machine draws conclusions and offers/initiates management
- Level I: AI suggests diagnosis/treatment options (contestable)
- Level II: AI initiates actions with override opportunity
- Level III: AI implements management (requires physician initiative to contest)
New 2025 Category III AI Codes
All seven new codes represent augmentative AI—machine analyzes data, but physician interprets results and makes clinical decisions.
Electrocardiogram AI Analysis
Medical Chest Imaging AI Analysis
Image-Guided Prostate Biopsy AI
Category III vs. Category I Codes
Category III codes are temporary codes for emerging technologies. Key characteristics:
- Five-character codes: Four digits + letter "T" (e.g., 0902T)
- Temporary status: Typically archived after 5 years unless moved to Category I
- FDA clearance required: Device/service must have FDA approval for clinical use
- Data collection: Help establish clinical utility and reimbursement rates
- Variable payer coverage: Commercial payers decide individually whether to reimburse
First Category I Augmentative AI Code
CPT 2024 introduced the first Category I code with AI Taxonomy descriptor:
This code represents the pathway for AI codes—start as Category III while evidence builds, then transition to permanent Category I status.
Why AI Taxonomy Matters for Coders
Understanding AI classification impacts coding accuracy:
- Separate reporting: AI analysis may be separately reportable from base imaging service
- Physician work component: Augmentative AI still requires physician interpretation (professional component billable)
- Bundling rules: Check NCCI edits for AI codes used with corresponding imaging codes
- Documentation: Physician report must reference AI analysis and clinical integration
CPC Exam Perspectives
✅ What to Know About AI Codes
- AI Taxonomy categories: Assistive, Augmentative, Autonomous (and 3 autonomous levels)
- 2025 codes are augmentative: All seven new codes (0902T, 0932T, 0877T-0880T, 0898T)
- Category III identifier: Four digits + "T" suffix
- Physician interpretation required: These aren't autonomous—doctor reviews AI output
- Emerging technology: Temporary codes subject to archival or Category I promotion
- Appendix S reference: CPT Appendix S contains full AI Taxonomy framework
Other Significant CPT 2025 Updates
Abdominal Tumor Resection Codes (49186-49190)
Five new codes for advanced surgical techniques in abdominal tumor elimination:
- 49186-49188: Different approaches for peritoneal tumor debulking
- 49189-49190: Additional complexity levels for extensive tumor involvement
These codes reflect advancements in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis.
Remote Therapeutic Monitoring (RTM) Revisions
Updates to RTM codes (98975-98978) to include:
- Digital therapeutic intervention: Code 98975 revised to capture app-based therapy
- Device supply tracking: Codes 98976-98978 now include device supply for data access/transmission
RTM differs from Remote Physiologic Monitoring (RPM)—RTM focuses on non-physiologic data like medication adherence, respiratory therapy compliance, or musculoskeletal therapy exercises.
Proprietary Laboratory Analyses (PLA) Codes
100 new PLA codes added—the single largest category of updates. Most involve:
- Genetic testing panels for hereditary conditions
- Pharmacogenomic testing (drug-gene interactions)
- Oncology molecular profiling
- Infectious disease multiplex assays
PLA codes follow unique alpha-numeric format and are found in Appendix O of CPT codebook.
Vaccine Administration Updates
New vaccine product codes reflect 2024-2025 formulations:
- Updated COVID-19 vaccine codes for 2024-2025 strains
- New combination vaccine codes
- Revised age-specific administration codes
Medicare Payment Considerations for 2025 Codes
⚠️ Critical Payment Information
New codes often have "contractor-priced" status initially, meaning Medicare Administrative Contractors (MACs) determine payment amounts locally until CMS establishes national rates. This affects:
- SCSA codes (15011-15018): Contractor-priced for 2025
- MRI safety codes (76014-76019): National payment rates established
- Telemedicine codes (98000-98015): Medicare status "I" = Invalid (not recognized)
- Category III codes: Variable coverage by MAC
How Contractor Pricing Works
- Initial claims submission: Providers may need to submit documentation justifying fees
- MAC review: Local Medicare contractor analyzes costs and determines payment
- Data collection period: 6-12 months of claims data gathered
- National rate determination: CMS eventually establishes standardized payment
2025 Medicare Physician Fee Schedule (MPFS)
Key payment rates for new codes (national averages, may vary by locality):
| Code | Global Period | Facility RVU | Non-Facility RVU |
|---|---|---|---|
| 76014 | XXX | N/A (TC only) | 0.53 |
| 76016 | XXX | 0.96 | 0.96 |
| 76017 | ZZZ | 0.87 | 0.87 |
| 98016 | XXX | 0.55 | 0.55 |
Note: RVU (Relative Value Unit) values multiplied by conversion factor ($32.35 for 2025) to determine Medicare payment.
Impact on CPC Exam & Study Strategies
What CPC Exam Questions Will Test
Likely Exam Scenarios for 2025 Updates
- Telemedicine coding: Case scenarios requiring code selection between 98000-98015, determining level by MDM or time
- SCSA procedures: Multi-code scenarios combining harvest, preparation, and application codes with correct sequencing
- MRI safety: Identifying when safety codes apply, time-based calculation for 76014/76015
- Code deletion awareness: Questions testing knowledge that 99441-99443 are deleted
- AI terminology: Distinguishing assistive vs. augmentative vs. autonomous AI
Study Strategies for New Codes
-
Create comparison charts:
- Compare telemedicine code structure to office visit codes (99202-99215)
- Chart SCSA code progression: harvest → prepare → apply
- Map MRI safety codes by timing (pre-exam vs. day-of-exam)
-
Practice time-based calculations:
- Telemedicine: If encounter is 38 minutes audio-video with established patient, low MDM = 98005
- MRI safety: If assessment takes 52 minutes = 76014 + 76015 + 76015
-
Memorize "part thereof" rules:
- SCSA harvest/preparation: 25 sq cm increments
- SCSA application: 480 sq cm increments
- Any portion of additional area qualifies for add-on code
-
Understand guideline changes:
- Read CPT guidelines for Telemedicine Services subsection
- Review Skin Cell Suspension Autograft subsection guidelines
- Study MR Safety Implant/Foreign Body Procedures section notes
-
Flag in your CPT book:
- Tab new subsections with distinctive color
- Annotate "NEW 2025" in margins for quick reference
- Highlight key parenthetical notes about separate reporting
Practice Questions
Self-Test: CPT 2025 Updates
- Q: Provider conducts 28-minute audio-video telemedicine visit with established patient, moderate complexity MDM. Which code?
A: 98006 (audio-video, established, moderate MDM, 30-39 minutes) - Q: Surgeon harvests 45 sq cm skin, processes it manually, applies SCSA to 950 sq cm burn on patient's back and legs. How many codes?
A: Six codes - 15011, 15012, 15013, 15014, 15015, 15016 - Q: MR technologist spends 20 minutes assessing pacemaker compatibility before MRI. Which code?
A: 76014 only (covers first 15 minutes; 20 minutes doesn't meet 30-minute threshold for 76015) - Q: Which telemedicine code is NOT recognized by Medicare?
A: All codes 98000-98015 (Medicare uses 99202-99215 with modifier 95/93)
High-Yield Study Checklist
✅ Master These for Exam Day
- ☐ Memorize telemedicine code ranges: 98000-98007 (audio-video), 98008-98015 (audio-only), 98016 (brief)
- ☐ Know time thresholds: 15/30/45/60 min (new), 10/20/30/40 min (established)
- ☐ Understand SCSA three-phase process and 8 codes (15011-15018)
- ☐ Identify MRI safety codes and time-based vs. non-time-based distinction
- ☐ Recognize AI taxonomy categories and new Category III codes
- ☐ Remember deleted codes: 99441-99443 (replaced by audio-only telemedicine)
- ☐ Know Medicare doesn't accept 98000-98015 (critical exam knowledge)
- ☐ Practice calculating add-on codes with "part thereof" rule
Resources & References for Continued Learning
Official CPT Resources
- CPT 2025 Professional Edition: Published by AMA, includes all code updates with guidelines
- CPT Assistant: Monthly newsletter with coding scenarios and official guidance (AAPC members get access)
- AMA CPT & RBRVS Symposium: Annual event covering code changes in depth
- CPT Appendix S: AI Taxonomy for Medical Services and Procedures (in CPT codebook)
Online Resources
- AAPC Knowledge Center: Articles on 2025 updates (aapc.com/blog)
- CMS MLN Matters Articles: Medicare payment and coverage details for new codes
- AMA CPT Code Change Summary: Free overview of major updates (ama-assn.org/cpt)
Study Tools
- Create flashcards for new code ranges and time thresholds
- Practice with AAPC mock exams updated for 2025 codes
- Join AAPC forums to discuss coding scenarios with peers
- Watch AAPC webinars on specific update topics (telemedicine, SCSA, etc.)
Ready to Practice CPT 2025 Coding?
Test your knowledge of new telemedicine codes, SCSA procedures, and all 2025 updates with our comprehensive practice questions.
Final Thoughts on CPT 2025
The 2025 updates represent meaningful progress in coding specificity and recognition of emerging technologies. For CPC candidates, these changes demonstrate why annual code book updates are essential—medicine evolves rapidly, and coding must keep pace.
Focus your study time on the high-impact changes: telemedicine codes, SCSA procedures, and MRI safety codes. These are most likely to appear on your exam and in real-world coding work. Understanding the AI Taxonomy positions you for the future of medical coding as artificial intelligence becomes increasingly integrated into healthcare.
Remember: Your 2025 CPT book is your primary reference on exam day. Familiarize yourself with new subsections, tab them distinctively, and practice navigating to these codes quickly. The more comfortable you are with the structure of new code families, the faster and more confidently you'll code on exam day.
Master these 420 updates, and you'll be well-prepared for the CPT portion of your CPC exam! 🚀📚