This quarter we focus on cardiology — a specialty at the epicenter of the most consequential coding overhaul in over a decade. The 2026 CPT changes weren’t just an update. They rewired how interventional, diagnostic, and EP services are reported, valued, and paid. Six months in, the practices that prepared are pulling ahead. Those that didn’t are living in their AR reports.
A Scenario from the Field
A four-physician interventional cardiology group has been billing PCI the same way for years. When the 2026 code changes took effect, their coders recognized the new complex PCI codes but weren’t trained on the revised documentation requirements — specifically, that operative reports must now describe lesion location, vessel segments, and bifurcation involvement with enough specificity to support the new code family. Three months in, they’re seeing a spike in technical denials and partial payments. The procedures are more complex than ever. The revenue doesn’t reflect it.
This is the story of 2026 for cardiology practices: a year where doing the right clinical work is no longer enough. The coding infrastructure behind that work has to keep up — or revenue quietly leaks out through downcodes, denials, and missed complexity capture.
The 2026 changes didn’t arrive in a vacuum. They land on top of the 2.5% efficiency adjustment cutting procedural RVUs, a mandatory new heart failure payment model for cardiologists in major metro areas, and the WISeR AI prior authorization pilot running in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. For cardiology practices in the Southwest, this isn’t an abstract policy conversation. It’s this quarter’s cash flow.
The Pressure Points This Quarter
Coding Volume
418 CPT changes — cardiology bears the biggest burden
The 2026 CPT set brought 288 new codes, 84 deletions, and 46 revisions. Cardiology is disproportionately affected. The PCI family was fully restructured — legacy add-on codes eliminated, new complex PCI and chronic total occlusion (CTO) codes added, and lower extremity revascularization expanded from 16 codes to 46. Every change requires updated coder training, documentation workflows, and billing system configuration. Practices that haven’t audited their claims since January are likely undercoding complex cases.
LER codes: 16 → 46 · Complex PCI: new dedicated code family
Site of Service
Facility-based cardiology services down 7% — office-based up 5%
The 2026 fee schedule’s practice expense recalibration hit facility-based cardiovascular services hard. Pacemaker implants, TAVR, PCI, and ablation performed in hospital settings saw indirect practice expense reductions of roughly 10%. Meanwhile, office-based non-facility services received a 5% bump. For cardiology groups splitting work between employed hospital settings and independent ASCs or offices, the site-of-service math has materially shifted. The good news: cardiac catheter ablation was added to the ASC covered procedures list — a long-advocated win creating new volume and revenue opportunity.
Facility-based: −7% · Non-facility: +5% · Ablation now covered in ASC
Mandatory Risk Model
The Ambulatory Specialty Model — a mandatory risk arrangement for heart failure
CMS finalized a mandatory five-year Ambulatory Specialty Model (ASM) for heart failure, affecting cardiologists in selected metro areas who treated at least 20 traditional Medicare HF patients. It’s a two-sided risk arrangement: payment adjustments of −9% to +9% on Medicare Part B reimbursements in the first payment year. This isn’t optional — it’s mandatory. Practices in qualifying CBSAs that haven’t mapped their HF patient panel, tracked quality metrics, or stress-tested financials under the downside risk scenario are flying blind.
Risk range: −9% to +9% on Part B · Five-year mandatory term
Opportunity
Remote physiologic monitoring — a genuine revenue expansion
New RPM codes for 2026 — including 99445 and 99470 — expand what cardiology practices can bill for device data capture and real-time patient interaction, with lower minimum-day thresholds than before. For practices managing patients with implanted devices, wearables, or remote cardiac monitors, this is recurring monthly revenue most groups are leaving uncaptured. Combined with the AI-coronary plaque assessment code now elevated to Category I, technology-enabled services are being recognized in ways they weren’t two years ago.
New RPM codes lower threshold to 2 days vs. prior 16-day minimum
Three Actions for This Quarter
1
Run a mid-year PCI and LER coding audit — immediately.
Six months of claims under the new code structure is enough data to reveal patterns. Pull your interventional claims from January through June. Are complex PCI cases being coded to the new complexity codes or defaulting to the old simple-stent code? Are LER procedures landing in the right one of the 46 new categories? Undercoding on a single complex PCI can mean $400–$800 in lost reimbursement per case. At volume, that’s a material number.
2
Map your site-of-service exposure and accelerate ASC volume where you can.
If a meaningful share of your ablation, cath, or peripheral intervention volume is currently facility-based, the 7% practice expense reduction is a standing drag on your revenue. Now that cardiac catheter ablation is on the ASC covered procedures list, evaluate whether shifting appropriate cases to your ASC or an independent facility improves your net reimbursement. The math often favors the move.
3
Start billing RPM if you have the patient panel to support it.
If your practice manages patients with implanted cardiac devices, remote monitors, or wearable cardiac trackers and you aren’t billing 99445 and 99470, you’re leaving monthly recurring revenue on the table. The new codes require real-time interaction with the patient or caregiver — build that touch into your device clinic workflow and you’ve created a billable encounter you were already having.
Work with Vaqya
Is your cardiology billing keeping pace with the 2026 changes?
Vaqya’s RCM team works with physician practices across specialties — including cardiology groups navigating the new PCI code family, ASM risk arrangements, and the WISeR prior auth environment in Arizona. If your denials are up or your AR is growing, let’s look at why.
Let’s talk →