Coding specialist reviews critical 2026 CPT updates

The American Medical Association makes code and guideline changes to the Current Procedural Terminology (CPT) Manual each year. This article previews changes to the musculoskeletal and nervous-system sections affecting orthopaedic procedures for 2026. For a full summary of the additions, deletions, and revisions, refer to Appendix B of the CPT Manual.

SI joint arthrodesis
Code-descriptor revisions were made to codes for sacroiliac (SI) joint arthrodesis, along with new parenthetical guidelines instructing that code 27278 cannot be reported in conjunction with code 27279 when they involve the same SI joint. An additional parenthetical guideline was added to instruct coders to report code 27279 for hybrid SI joint-fusion procedures. Corresponding instructional parenthetical guidelines were added to pelvic bone fracture codes 27216 and 27218 and throughout the code set to note these changes and provide further instruction on the reporting of these codes.

Revised codes are as follows (underlined text denotes revisions):

• 27278, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, includes obtaining bone graft when performed, unilateral; placement of intra-articular device(s), without cortical piercing
• 27279, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, includes obtaining bone graft when performed, unilateral; placement of transarticular device(s) and/or intra-articular device(s) piercing the lateral or medial cortices of the ilium and the lateral cortex of the sacrum

Clarifying revisions were made to the code descriptors to define the required elements to perform and report the procedure.

The previous code descriptors for 27278 and 27279 separated the procedures based on whether the fusion involved either:

• Use of an internal fixation device of the SI joint, which passes through the ilium, across the SI joint and into the sacrum, thus transfixing the SI joint, or
• The percutaneous placement of an intra-articular stabilization device into the SI joint to stabilize the joint, typically through a percutaneous posterior approach

The term “transfixation” was replaced with the terms “intra-articular” and “transarticular.” These terms clarify whether the fixation device is intra-articular (placed within the joint) or transarticular (placed across the joint). The revised code descriptors further categorize whether the device(s) pierces the cortices of the ilium or sacrum (27279) or not (27278).

Femur (thigh region) and knee joint
The knee arthroplasty code 27445, hinge prosthesis (e.g., Walldius type), was deleted to reflect current clinical methods. Also, a new code was added: 27458, Osteotomy(ies), femur, unilateral, with insertion of an externally controlled intramedullary lengthening device, including iliotibial band release when performed, imaging, alignment assessments, computations of adjustment schedules, and management of the intramedullary lengthening device.

Code 27458 was created for the reporting of femoral osteotomies, with the insertion of an externally controlled intramedullary lengthening device to treat limb-length discrepancies due to congenital deformities, infections, or trauma. A parenthetical guideline has been added that prohibits this code from being reported in combination with knee codes 27450, 27466, 27470, 27472, or 27506.

Leg (tibia and fibula) and ankle joint
For 2026, a new code was created related to treatment of the leg and ankle: 27713, Osteotomy(ies), tibia, including fibula when performed, unilateral, with insertion of an externally controlled intramedullary lengthening device, including imaging, alignment assessments, computations of adjustment schedules, and management of the intramedullary lengthening device.

Code 27713 was created for the reporting of tibial osteotomy(ies), including fibula, when performed with the insertion of an externally controlled intramedullary lengthening device in cases where the bone is lengthened or realigned. A parenthetical guideline has been added which prohibits the reporting of this code with knee codes 27705, 27709, 27712, 27715, 27720, 27722, 27724, or 27759.

Spine and spinal cord
The updated manual has revised the following code: 62287, Decompression, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle-based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar.

Code 62287 was moved to the subsection Injection, Drainage, or Aspiration, and the term “procedure” was deleted from the code descriptor. An instructional parenthetical note was added, directing coders to report new codes 62330 and 62331 for percutaneous lumbar decompression with non-needle-based technique.

New subsection: Percutaneous Decompression of Neural Elements
This new subsection was created for two new lumbar decompression codes. The previous Category III code 0275T was deleted and converted into Category I codes 62330 and 62331:

• 62330, Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; one interspace, lumbar
• 62331, Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; additional interspace(s), lumbar (List separately in addition to code for primary procedure)

Codes 62330 and 62331 were created for the reporting of bilateral percutaneous interlaminar lumbar decompression with partial removal of the ligamentum flavum. Code 62330 is for the first interspace, and add-on code 62331 is for each additional lumbar interspace. Note, add-on code 62331 cannot be reported more than once per session. Because these procedures are bilateral, parenthetical guidelines were added to instruct users to append modifier 52 when a unilateral procedure is performed.

Posterior extradural laminotomy or laminectomy
A new add-on code was created for the section Posterior Extradural Laminotomy or Laminectomy for Exploration/Decompression of Neural Elements or Excision of Herniated Intervertebral Discs:

• + 63032, Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; with repair of annular defect by implantation of bone-anchored annular closure device, including all imaging guidance, 1 interspace, lumbar (List separately in addition to code for primary procedure)

Add-on code 63032 was created for the reporting of laminotomy (hemilaminectomy) with decompression for one interspace using an annular defect closure device.

This device treats the defect in the annulus after disk removal and completion of the decompression. The comprehensive procedure additionally includes decompression components typically performed as part of other laminotomy/hemilaminectomy decompression procedures, such as excision of herniated disk material, freeing of the nerve roots, opening of the foramen, and partial facet removal.

Parenthetical guidelines instruct users to report this add-on code only once per session and further restrict reporting of 63032 in conjunction with re-exploration laminotomy code 63042.

New Category III guideline
For percutaneous laminotomy code 0274T, a parenthetical guideline was added, instructing when a percutaneous interlaminar lumbar decompression without laminotomy/laminectomy is performed to see codes 62287, 62330, or 62331.

The changes outlined above are merely a preview of the changes detailed in CPT 2026. Please refer to the CPT Manual for all coding changes for 2026.

Michelle Abraham, MHA, CCS-P, is the coding and reimbursement coordinator for the AAOS Office of Government Relations.