Pathology CPT Code Changes 2026: Billing, Documentation & Compliance

The 2026 pathology CPT code changes include 7 new codes, 2 revised codes, and 2 deleted codes affecting clinical laboratory billing and reimbursement. These updates from the American Medical Association (AMA) impact infectious disease testing, cytogenomic analysis, oncology diagnostics, and antimicrobial susceptibility studies, effective January 1, 2026.

Overview of 2026 CPT Code Updates

The AMA released 288 new CPT codes, 84 deleted codes, and 46 revised codes across all specialties for 2026. Healthcare providers must update billing systems, train staff, and modify documentation practices to maintain compliance and accurate reimbursement.

Which New Pathology and Laboratory CPT Codes Were Added in 2026?

New pathology codes include:

• 81354 for cytogenomic analysis
• 81524 for CNS tumor DNA methylation analysis
• 87182-87183 for carbapenemase detection

The AMA added these codes to reflect advances in genetic testing, infectious disease diagnostics, and antimicrobial resistance detection.

New Code 81354: Cytogenomic Analysis

81354 covers cytogenomic analysis for constitutional chromosomal abnormalities using optical genome mapping (OGM). This code interrogates structural and copy number variants through genome-wide analysis.

The code applies to:

• Constitutional chromosomal abnormality detection
• Structural variant analysis
• Copy number variant identification
• Optical genome mapping methodology

New Code 81524: CNS Tumor Methylation Analysis

81524 covers oncology testing for central nervous system tumors through DNA methylation analysis of 10,000 or more methylation sites. This code utilizes DNA extracted from formalin-fixed tumor tissue and reports the probability of matching reference tumor families.

Key reporting elements include:

• Probability of matching the reference tumor family and class
• MGMT promoter methylation status
• Algorithm-based classification results
• Formalin-fixed tissue specimen requirements

New Codes 87182-87183: Carbapenemase Detection

87182 detects carbapenemase enzymes, including KPC, NDM, and VIM, via a multiplex immunoassay. This qualitative test identifies antibiotic resistance mechanisms per isolate.

87183 identifies carbapenem resistance genes, including blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP using the amplified probe technique. This molecular test detects genetic markers of antibiotic resistance per isolate.

Both codes address:

• Klebsiella pneumoniae carbapenemase detection
• New Delhi metallo-beta-lactamase identification
• Verona integron-encoded metallo-beta-lactamase testing
• Carbapenem resistance gene analysis

New Code 87494: Chlamydia and Gonorrhea Testing

87494 covers infectious agent detection for Chlamydia trachomatis and Neisseria gonorrhoeae using the multiplex amplified probe technique. This code combines both pathogens in a single test.

New Code 87627: Joint Space Pathogen Detection

87627 detects joint-space pathogens and drug-resistance genes using a multiplexed probe-based amplification technique, testing 26 or more targets. This comprehensive panel simultaneously identifies multiple infectious agents and antimicrobial resistance markers.

New Code 87812: COVID-19 and Influenza Combination Test

87812 covers infectious agent antigen detection for SARS-CoV-2 and influenza virus types A and B using an immunoassay with direct optical observation. This point-of-care test provides visual interpretation for three viral pathogens.

What Are the Revised Pathology CPT Codes for 2026?

Revised codes 83015 and 83018 update heavy metal testing descriptors to include additional analytes like gadolinium. The modifications expand the list of detectable heavy metals and clarify the distinction between quantitative and qualitative testing.

Revised Code 83015: Qualitative Heavy Metal Testing

83015 now covers qualitative heavy metal testing for antimony, arsenic, barium, beryllium, bismuth, gadolinium, and mercury. This code enables testing for any number of analytes in qualitative mode.

Revised Code 83018: Quantitative Heavy Metal Testing

83018 provides quantitative heavy metal testing for antimony, arsenic, barium, beryllium, bismuth, gadolinium, and mercury. This code bills per analyte for metals not elsewhere specified.

The revision adds:

• Gadolinium to the list of testable metals
• Clarification of quantitative methodology
• Per-analyte billing specification
• Distinction from other heavy metal codes

Which Pathology CPT Codes Were Deleted in 2026?

Deleted codes 0450U and 0451U for multiple myeloma liquid chromatography with tandem mass spectrometry testing are no longer valid after December 31, 2025. Healthcare organizations must identify alternative codes for these services.

Deleted Code 0450U: Monoclonal Paraprotein Sequencing

0450U covered oncology testing for multiple myeloma using LC-MS/MS for monoclonal paraprotein sequencing analysis. This baseline test reported the presence or absence of detectable clonotypic peptides in serum.

Deleted Code 0451U: Peptide Ion Quantification

0451U covered oncology testing for multiple myeloma using LC-MS/MS for peptide ion quantification. This test compared results with the baseline to determine monoclonal paraprotein abundance.

• Laboratories performing these tests must:
• Identify replacement codes or unlisted procedure codes
• Update charge masters by December 31, 2025
• Notify payers of code transitions
• Modify billing software and fee schedules

How Do Heavy Metal Testing Code Revisions Affect Laboratory Billing?

Revised codes 83015 and 83018 expand heavy metal testing to include gadolinium and clarify billing for multiple analytes. The updates address increased demand for gadolinium testing related to MRI contrast exposure.

Billing Code 83015 for Qualitative Heavy Metal Testing

Code 83015 allows billing for the qualitative detection of any number of heavy metals in a single specimen. This code does not bill per analyte but covers the entire qualitative panel.

Use code 83015 when:

• Performing screening for multiple heavy metals
• Reporting presence or absence without quantification
• Testing includes antimony, arsenic, barium, beryllium, bismuth, gadolinium, or mercury
• Results are qualitative only

Billing Code 83018 for Quantitative Heavy Metal Testing

Code 83018 bills per analyte for quantitative heavy metal measurement. This code requires specific concentration reporting for each metal tested.

Use code 83018 when:

• Providing quantitative results with numeric values
• Measuring specific heavy metal concentrations
• Testing metals not covered by other specific CPT codes
• Reporting individual analyte results separately

What Are Common Billing Errors to Avoid with 2026 Pathology Codes?

Common errors include using deleted codes after December 31, 2025, billing 87182 and 87183 together for the same isolate, and reporting 81524 without meeting the 10,000 methylation site threshold. These mistakes result in claim denials and payment delays.

Top 5 Pathology Billing Errors for 2026

• Billing deleted codes 0450U or 0451U after the transition deadline – causes automatic denial.
• Reporting codes 87182 and 87183 on the same bacterial isolate violates NCCI edits.
• Using code 81524 for methylation analysis under 10,000 sites – fails code descriptor requirements.
• Billing code 83018 without quantitative results – requires a numeric concentration value.s
• Missing optical genome mapping methodology documentation for code 81354 – produces medical necessity denials.

Conclusion

The 2026 pathology and laboratory CPT code changes require laboratories to implement 7 new codes, update 2 revised codes, and discontinue 2 deleted codes by January 1, 2026. These updates expand testing capabilities for 

• Cytogenomic analysis
• CNS tumor classification
• Antimicrobial resistance detection
• Infectious disease diagnostics

Healthcare organizations need to update their billing systems to ensure accurate coding. Laboratories should refer to the AMA CPT 2026 codebook for complete implementation guidance. Oregon Billing Service provides comprehensive support for laboratories transitioning to new coding requirements. Contact us now!

FAQs

How many new CPT codes have been added to the 2025 CPT changes?

There are a total of 270 new codes, 420 overall updates in the CPT 2025 code set, including 270 new codes, 112 deletions, and 38 revisions.

What are the 2026 ICD-10 code changes?

For 2026, the update includes 487 new diagnosis codes, 38 R-code revisions, and 28 invalidated or deleted codes.

Are CPT codes changing in 2026?

Key updates in the CPT 2026 code set include new codes for digital health services such as remote patient monitoring, medical services involving hearing devices and augmented intelligence (AI), and a comprehensive update to codes for leg revascularization.