Imaging, Radiology, and Endovascular Updates (2026)
Radiology and interventional services are undergoing significant coding changes in 2026, especially for CT angiography (CTA), CT perfusion (CTP), and ablation procedures. These updates affect head and neck imaging, endovascular therapy, and several high-complexity interventions. Coders and providers must be prepared to adjust documentation and code selection processes to remain compliant.
Key 2026 Coding Changes
Several former Category III codes are being upgraded and replaced with new Category I CPT® codes, signaling that these services are now considered standard of care:
Major updates include:
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New Category I codes for head and neck CTA
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New Category I codes for CT perfusion (CTP) imaging
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New codes for irreversible electroporation (IRE) of the liver and prostate
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Newly structured reporting for thoracic branch endograft procedures
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Revised prostate biopsy codes
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Updated coding rules for sacroiliac arthrodesis
These updates aim to improve clarity, reporting accuracy, and data tracking of complex imaging and endovascular services.
Imaging Guidance and Bundling Changes
Significant changes are occurring in how imaging guidance is reported. In 2026, there are expanded bundling rules that directly impact procedures previously reported separately.
Key guideline updates include:
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Revisions to vascular embolization/occlusion reporting rules
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Updated definitions and structure for endovascular therapy
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Bundling of certain imaging guidance services, such as fluoroscopy, CT, and ultrasound
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Changes to how legacy guidance codes like 61624 and 61626 are reported and bundled
This means coders can no longer assume imaging guidance is separately reportable unless clearly indicated in the new CPT® descriptors and guidelines.
Documentation Requirements Under 2026 Rules
Accurate documentation is now more critical than ever. Providers must clearly document:
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The imaging modality used (CT, CTA, CTP, fluoroscopy, ultrasound)
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Whether imaging guidance is bundled or separately reportable
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The approach (endovascular vs. open)
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The vascular territory treated
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The device types used (stents, coils, grafts, IRE probes)
Coders must also delete obsolete codes and map older services to the new CPT® structure beginning January 1, 2026.
Coding Tips for CTA, CTP, and Ablation (2026)
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Always verify which imaging modality was used.
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Confirm if the imaging guidance is now bundled under the new rules.
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Review Category I replacements for former Category III CTA and CTP services.
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Check for updated descriptors for IRE ablation of the liver and prostate.
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Ensure documentation reflects the vascular territory, approach, and device.
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Stay updated on guideline revisions for embolization and endovascular therapy.
The 2026 updates represent a major shift in how advanced imaging, ablation, and endovascular procedures are coded and reported. Transitioning away from older codes and adapting to new structured reporting will require close collaboration between providers and coding teams. Proper documentation and education are essential to ensure accurate reimbursement and compliance.