Thursday, September 10, 2026

The American Medical Association published the full CPT 2027 code set on September 9. The update includes new, revised, and deleted codes that will take effect for services on or after January 1, 2027. This annual update is critical for billing teams to implement changes to charge masters, EHR systems, and claim forms before year-end. Practices should secure their updated CPT manuals and identify any code changes that affect their top procedures. The next step is to check with your EHR vendor and clearinghouse for their implementation timelines and to schedule internal training sessions for coders and providers by mid-December.

Legislators introduced a bill that would force health insurers to provide a specific, human-understandable reason for any claim denial made using an automated system or artificial intelligence. The proposal aims to address opaque "black-box" denials, where providers and patients cannot challenge a decision because the algorithm's logic is not disclosed. While the bill is in early stages, it signals growing regulatory scrutiny on payer AI tools and could reshape appeal workflows. For now, document all instances where a denial reason cites "automated review" or "clinical criteria" without actionable detail, as this builds the case for challenging such policies.

A CMS payment proposal is raising concerns among speech-language pathologists. The change could reduce or eliminate reimbursement for speech therapy services provided on the same day as certain other Medicare services, such as a physician visit. If finalized, this would force clinics to either schedule patients for separate days, potentially disrupting care, or absorb the financial loss for combined visits. The rule is not yet final; CMS is reviewing comments. Practices with integrated rehab and physician services should monitor the Federal Register for the final rule and model the revenue impact on their most common visit combinations.

The Centers for Medicare & Medicaid Services has deferred more than $1 billion in Medicaid payments to states under a newly finalized rule. The rule also grants CMS new authority to exclude providers from Medicaid participation. This power shift is part of an enforcement push tied to program integrity measures. Deferred payments affect state budgets immediately, while the exclusion authority introduces a significant new compliance risk for providers with significant Medicaid patient panels. Monitor CMS-issued guidance for specifics on the new exclusion criteria, as this could impact credentialing and network participation for practices with high Medicaid volumes.

UnitedHealthcare's CFO stated the company plans to be "very competitive" in the 2027 Medicare Advantage market, signaling an aggressive posture after recent MA plan losses and enrollment shifts. This suggests UHC may leverage pricing, benefit design, or provider network expansions to regain market share. For provider practices, a major payer doubling down on MA growth could mean renewed network contracting pressure and shifts in patient panel mix. This announcement follows a period of high MA disenrollment and plan exits, marking a potential industry inflection point.