2026 CPT Code Changes: What Dental Billers & Coders Must Know

Published by the American Dental Coders Association

Every January 1 brings a new CPT® code set—and for dental billers and coders who work medical claims (or support oral surgery/OMS), those changes can ripple into prior authorizations, documentation templates, fee schedules, and claim edits. The 2026 CPT® update is a big one: the AMA announced 288 new codes, 46 revised codes, and 84 deleted codes (418 total changes). :contentReference[oaicite:0]{index=0}

This post breaks down what matters most for the dental side of the world—especially when you’re:

• Cross-coding dental services to medical (sleep, trauma, pathology, imaging, hospital dentistry)
• Supporting oral & maxillofacial surgery (OMS) and anesthesia workflows
• Handling medically necessary adjunctive services (radiology, pathology, complex surgical procedures)
• Training teams to avoid denials by matching documentation to updated CPT descriptors

Quick refresher: Why CPT changes matter in dentistry

Most routine dentistry is billed with CDT. But CPT becomes relevant whenever a dental service is billed to medical—common examples include:

• Trauma and medically necessary reconstruction
• Oral surgery performed in an ASC/hospital setting (and related anesthesia services)
• Pathology (biopsy specimens and medical pathology billing workflows)
• Imaging billed through medical pathways (especially when payer policy requires CPT-based reporting)
• Sleep medicine workflows (e.g., oral appliance therapy coordination with medical providers)

Bottom line: even if your day-to-day is CDT, CPT changes can alter what payers expect on the medical side—especially in cross-coding scenarios.

What changed in CPT 2026 (high-level)

The AMA’s 2026 release emphasizes modernization to reflect current care delivery, including technology-enabled services and major procedure-family updates. :contentReference[oaicite:1]{index=1}

1) New and expanding digital health and technology services

One of the headline themes is continued growth in technology-enabled reporting, including digital health and AI/augmented intelligence services. :contentReference[oaicite:2]{index=2}

Dental cross-coding implication: If your practice supports medical coordination (sleep, remote monitoring programs managed by physicians, medically necessary follow-up tracking), you may see new or revised CPT pathways that affect how medical partners bill—and what documentation they request from dental teams (e.g., device delivery dates, compliance data, treatment plans, and outcomes).

2) Major updates in select surgical “families”

The AMA specifically called out a comprehensive modernization of the lower extremity revascularization section (with broad deletions and 46 new codes in that area). :contentReference[oaicite:3]{index=3}

Dental cross-coding implication: Even when changes aren’t “dental,” they affect payer edit logic and systems. Any major overhaul can trigger clearinghouse/payer reconfigurations early in the year—meaning you may see an uptick in front-end rejections, payer requests for corrected coding, or temporary payer confusion in Q1.

3) Specialty guidance and section-level reorganizations

Multiple professional bodies publish specialty-focused explanations of CPT 2026 changes to help clinicians and coders apply the updates correctly. :contentReference[oaicite:4]{index=4}

Dental cross-coding implication: For OMS and hospital dentistry workflows, specialty commentary is often where you’ll find the practical “how to report” guidance that helps prevent denials.

How these updates show up in real dental billing work

Scenario A: OMS + anesthesia (facility or hospital cases)

When oral surgery is performed in a facility environment, your claim ecosystem can involve:

• Professional services (surgeon)
• Anesthesia (anesthesiologist or dental anesthesia provider, depending on setting and credentialing)
• Facility billing (ASC/hospital)
• Radiology/pathology ancillary claims

What to watch in 2026:

• Descriptor changes can alter documentation requirements. If a code is revised, your note template may need updates.
• Deleted codes can trigger denials if your practice management or encoder isn’t updated.
• Payer policy may lag—so you need a clean internal “what we bill” crosswalk for Q1.

Practical tip: Build an “OMS case packet” checklist that includes the exact documents payers request when dental services are billed medically (op report, diagnosis support, imaging report, pathology report if applicable, and a concise medical necessity narrative).

Scenario B: Pathology workflows (biopsies and specimens)

Oral biopsies can trigger medical pathology billing. Whether your office bills pathology directly (less common) or coordinates with a pathology lab (more common), CPT changes can influence:

• How the lab reports services
• What documentation is required to link specimen, site, and diagnosis
• How quickly denials occur when diagnosis/procedure pairing is weak

Practical tip: Standardize specimen labeling and include a short, consistent clinical history statement that supports medical necessity and reduces “insufficient information” denials.

Scenario C: Medical cross-coding for medically necessary dental care

When you submit medical claims tied to dental conditions (trauma, reconstruction, medically necessary services), CPT updates can change how payers interpret the procedure line—even when your clinical work is the same.

Practical tip: Re-audit your top 20 medical-cross-coded procedures in January and confirm:

• The CPT code is still active (not deleted)
• The descriptor matches your documentation
• Diagnosis selection supports medical necessity
• Any payer-specific rules are captured in your internal playbook

Top “impact points” to build into your 2026 training

Because the 2026 code set includes hundreds of changes, the goal for dental teams is not memorization—it’s building a repeatable process for compliance and clean claims.

Impact Point 1: Active code validation (avoid deleted-code denials)

Deleted codes are a fast path to denials and rejections. CPT 2026 includes 84 deletions. :contentReference[oaicite:5]{index=5}

Action: Ensure your practice management system, clearinghouse edits, and coding references are updated for 2026—and run a “soft test” by checking your most common medical submissions in early January.

Impact Point 2: Documentation alignment for revised descriptors

Revised codes are tricky because your team may keep using the code “the old way.” CPT 2026 includes 46 revised codes. :contentReference[oaicite:6]{index=6}

Action: For any revised code you use, update:

• Clinical note templates
• Claim narratives (when you include them)
• Prior auth packets
• Internal coding policies

Impact Point 3: Payer lag (January–March reality)

In Q1, payers sometimes lag behind code-set updates or apply edits inconsistently—especially after major code-family overhauls. If you see unusual denials, document patterns and escalate with clear examples.

2026 CPT readiness checklist for dental billers & coders

• Update tools: Confirm 2026 CPT references/encoders are active in your workflow.
• Rebuild your “Top CPT List”: Identify your most-used medical/CPT codes for dental cross-coding and validate their status (active/revised/deleted).
• Refresh templates: Align note templates and claim narratives with revised descriptors.
• Verify payer policies: Check top payers for new prior auth requirements, documentation changes, and any year-turn announcements.
• Run a January audit: Pull the first 10–20 medical claims of the year and review for edits, rejections, and trends.
• Create an escalation log: Track payer responses, representative guidance, and reference numbers for recurring issues.
• Train the team: Hold a short “2026 CPT changes” huddle focused on your practice’s actual CPT usage.

Real-world example templates you can copy into your workflow

Sample medical necessity narrative (editable)

Use case: Attach to claims when you routinely see “not medically necessary” or “insufficient information” denials.

Patient presents with [condition/diagnosis] with functional/medical impact including [pain/infection/airway/trauma/other]. Service performed: [procedure] on [date], supported by [imaging findings/pathology/clinical exam]. Treatment aligns with medical necessity due to [brief justification]. Relevant records included: [op note, imaging report, pathology report, referral, prior auth].

OMS case packet checklist (printable)

• Face sheet / demographics / insurance
• Referral (if applicable)
• Clinical notes (H&P and exam)
• Imaging report (and images when required)
• Operative report with clear procedure details
• Anesthesia record (if billed separately)
• Pathology report (if specimen submitted)
• Medical necessity narrative (when needed)

Practice exercises (for students and teams)

If you train new billers/coders or want to sharpen your internal QA, these short exercises help the team apply the update mindset—without trying to memorize the entire code set.

Exercise 1: “Deleted code defense”

Task: Pick 10 CPT codes your practice used in 2025 for medical claims. Verify each remains active in 2026 and document your source. If any are deleted or revised, write the corrective action you’ll take (template update, code replacement, payer notice, etc.).

Exercise 2: “Descriptor alignment”

Task: Choose 3 procedures that commonly require narratives. Rewrite the narrative so it clearly matches the key elements payers expect (who/what/why/records attached). Compare denial rates before and after implementation.

Exercise 3: “Q1 denial triage”

Task: Review your first 15 medical EOBs/ERAs of 2026. Categorize denials into:

• Eligibility/coverage
• Invalid/inactive code
• Medical necessity
• Documentation missing
• Prior auth/referral
• Bundling/edit logic

Then, write one prevention step for each category.

Where to get training support (and keep your team current)

If you want a structured pathway for strengthening medical cross-coding judgment, documentation habits, and compliance workflows, build CPT/Cross-coding best practices into your continuing education plan.

Explore training through ADCA:

• Certified Dental Billing Specialist (CDBS) training for end-to-end claim workflows and payer processes
• Certified Dental Coder (CDC) training for coding mastery, compliance, and documentation strategy
• When you’re ready to certify: CDBS Exam and CDC Exam

And if you have a tricky cross-coding question, use Ask-The-Coder—a Knowledge Base where anyone can ask Dental Billing and Dental Coding questions for free.

Join the community

Want ongoing support, updates, and professional resources? Consider joining ADCA Membership to stay connected with training, tools, and community guidance from ADCA.

Key takeaways for 2026

• CPT 2026 is a high-change year (418 total changes) and will influence payer edits and documentation expectations. :contentReference[oaicite:7]{index=7}
• Dental teams should focus on process: validate active codes, update templates, and audit Q1 outcomes.
• Cross-coding success in 2026 will hinge on documentation alignment and well-built case packets—especially for OMS, anesthesia, pathology, and medically necessary services.

Tip: If you want, paste a de-identified example of one of your common medical-cross-coded claim scenarios (procedure type + what the payer denied for), and I’ll help you build a tighter narrative + documentation checklist for that scenario.