Imaging, Radiology, and Endovascular Updates (2026)
Radiology and interventional services face significant coding changes in 2026. In particular, the changes affect CT angiography (CTA), CT perfusion (CTP), and ablation procedures. These updates touch head and neck imaging, endovascular therapy, and several high complexity interventions. As a result, coders and providers must adjust their documentation and code selection to stay compliant.
Key 2026 Coding Changes for CTA, CTP, and Ablation Procedures
Several former Category III codes are moving to new Category I CPT codes. In other words, these services are now considered standard of care.
The 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
Together, these updates aim to improve clarity, reporting accuracy, and data tracking for complex imaging and endovascular services.
Imaging Guidance and Bundling Changes
The way coders report imaging guidance is also changing. In 2026, expanded bundling rules directly affect procedures that coders 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
Therefore, coders can no longer assume imaging guidance is separately reportable. Instead, report it only when the new CPT descriptors and guidelines clearly allow it.
Documentation Requirements Under 2026 Rules
Accurate documentation is now more critical than ever. Providers must clearly document the following:
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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)
In addition, coders must stop using deleted codes and map older services to the new CPT structure beginning January 1, 2026.
Coding Tips for CTA, CTP, and Ablation (2026)
First, always verify which imaging modality the provider used. Next, confirm whether the new rules bundle the imaging guidance. Also, review the Category I replacements for former Category III CTA and CTP services, and check the updated descriptors for IRE ablation of the liver and prostate. Make sure the documentation reflects the vascular territory, approach, and device. Finally, stay updated on guideline revisions for embolization and endovascular therapy.
The 2026 updates represent a major shift in how coders report advanced imaging, ablation, and endovascular procedures. Moving away from older codes will require close collaboration between providers and coding teams. Above all, proper documentation and education are essential for accurate reimbursement and compliance.