The Centers for Medicare & Medicaid Services (CMS) has finally unveiled the 2025 Annual Update to the List of CPT/HCPCS Codes effective from January 1, 2025, and bringing unprecedented changes that would essentially redefine the requirements for medical billing compliance.
The update sees the addition of 130 codes and the deletion of 23 codes, the most significant augmentation in CMS-certified health services codes ever and requires immediate attention from healthcare providers and billing partners.
Context for the Physician Self-Referral Regulation:
Physician self-referral statute, which is codified under Section 1877 of the Social Security Act and more commonly known as the Stark Law, prohibits doctors from referring for some designated health services for which Medicare pays, to entities with whom they have financial relationships.
The elaborate regulatory system ensures that financial choices are subordinated to choices that are in the best interest of patient well-being and covers both ownership interests and compensation relationships.
Call-in prescription drugs fall into one category that has a designated CPT/HCPCS code that CMS reissues each year to keep current with changes in prescription therapy and practice patterns.
- Clinical laboratory services
- Occupational, physical therapy, and outpatient speech-language therapy services
- Radiology and other imaging services
- Radiation therapy service and supplies
Complete 2025 Code Additions by Category:
The updates to the 2025 codes make sweeping changes within each coded category for a specified health service. The following are the tables for each and every addition for codes, as they appear in the official CMS document:
1. Clinical Laboratory Services - Code Additions (2025)
Clinical laboratory services experienced the most rapid growth, adding 95 codes and removing only 9, for a total net addition of 86 codes. The additions include unparalleled advances in oncology testing, genetic diagnostics, and detection of infectious disease:
| CPT/HCPCS Code | Description |
|---|---|
| 0020M | Oncology (central nervous system), analysis of 30,000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue |
| 0898T | Noninvasive prostate cancer estimation map, derived from augmentative analysis of image-guided fusion biopsy and pathology |
| 0248U | Oncology (brain), spheroid cell culture in a 3D microenvironment, 12 drug panel, brain- or brain metastasis-response prediction for each drug |
| 0439U | Cardiology (congenital heart disease), DNA analysis, 5 single nucleotide polymorphisms (SNPs), 3 DNA regions |
| 0440U | Cardiology (congenital heart disease), DNA analysis, 10 single nucleotide polymorphisms (SNPs), 6 DNA regions |
| 0441U | Infectious disease (bacterial, fungal, viral), semi-quantitative detection |
| 0442U | Infectious disease (respiratory infection), multiplex assay, CRP and MxA |
| 0443U | Neurofilament light chain, ultrasensitive immunoassay |
| 0444U | Oncology (solid organ neoplasm), tissue genomic sequence analysis panel, 361 genes |
| 0445U | Amyloid beta 42 and phosphorylated tau 181, enzyme-linked immunosorbent assay (ELISA), cerebrospinal fluid |
| 0446U | Autoimmune disease (systemic lupus erythematosus), analysis of 10 cytokines |
| 0447U | Autoimmune disease (systemic lupus erythematosus), analysis of 11 cytokines |
| 0449U | Carrier screening (severe inherited conditions), 5 genes analysis |
| 0450U | Oncology (multiple myeloma), liquid chromatography with tandem mass spectrometry, monoclonal protein |
| 0451U | Oncology (multiple myeloma), liquid chromatography with tandem mass spectrometry, peptide ion quantification |
| 0452U | Oncology (bladder), DNA methylation analysis of PENK gene, quantitative methylation-specific PCR |
| 0453U | Oncology (colorectal cancer), cell-free DNA, quantitative PCR assay |
| 0454U | Rare disease identification, optical genome mapping |
| 0455U | Infectious agent (sexually transmitted infection), multiplex amplified probe technique, urine |
| 0457U | PFAS (per- and polyfluoroalkyl substances), 9 compounds, liquid chromatography with tandem mass spectrometry, plasma/serum |
| 0458U | Oncology (breast cancer), S100 A8 and A9 proteins, enzyme-linked immunosorbent assay |
| 0459U | Amyloid beta 42 and total tau, enzyme-linked chemiluminescent immunoassay, cerebrospinal fluid |
| 0460U | Oncology (whole blood/buccal), real-time PCR analysis, 24 genes |
| 0461U | Oncology (pharmacogenomic analysis), real-time PCR analysis, 24 genes |
| 0462U | Melatonin level test, sleep study (7/9 collection) |
| 0463U | Oncology (cervix), mRNA gene expression profiling, 14 biomarkers |
| 0464U | Oncology (colorectal), screening, quantitative real-time signal amplification of DNA markers |
| 0465U | Oncology (urothelial carcinoma), DNA quantitative methylation-specific PCR, 2 genes |
| 0466U | Cardiovascular (coronary artery disease), DNA genome-wide association study, 564,856 single nucleotide polymorphisms |
| 0467U | Oncology (bladder), DNA next-generation sequencing analysis, 60 genes and aneuploidy |
| 0468U | Hepatology (nonalcoholic steatohepatitis), microRNA-34a-5p, alpha-2-macroglobulin, and YKL-40 |
| 0469U | Rare disease (whole genome sequencing), fetal sample |
| 0470U | Oncology (oropharyngeal), detection, minimal residual disease, 8 DNA human papillomavirus types |
| 0471U | Oncology (colorectal cancer), 35 variants in KRAS and NRAS genes |
| 0472U | Connective tissue disorder (Sjögren syndrome), anti-PSP and anti-SP1 antibodies |
| 0473U | Oncology (solid tumor), blood/saliva, 648 gene analysis |
| 0474U | Hereditary (pancreatic cancer), genomic sequence analysis panel, 88 genes, next-generation sequencing |
| 0475U | Hereditary (prostate cancer), genomic sequence analysis panel, 23 genes |
| 0476U | Drug metabolism (psychiatric), 14 genes and CYP2D6 analysis |
| 0477U | Drug metabolism (psychiatric), 14 genes and CYP2D6 gene-drug interactions |
| 0478U | Oncology (non-small cell lung cancer), DNA and RNA digital PCR analysis, 9 genes |
| 0479U | Tau phosphorylated (ptau217), immunoassay |
| 0480U | Infectious disease (cerebrospinal fluid), metagenomic next-generation sequencing analysis |
| 0481U | IDH1, IDH2, and TERT promoter, next-generation sequencing |
| 0482U | Obstetrics (preeclampsia), biochemical assay, sFlt-1 and PlGF |
| 0483U | Infectious disease (Neisseria gonorrhoeae), GyrA S91F point mutation |
| 0484U | Infectious disease (Mycoplasma genitalium), 23S rRNA point mutation |
| 0485U | Oncology (solid tumor), cell-free DNA and RNA, next-generation sequencing |
| 0486U | Oncology (pan-solid tumor), next-generation sequencing, cell-free circulating tumor DNA |
| 0487U | Oncology (solid tumor), cell-free circulating DNA, targeted genomic sequence analysis panel, 84 genes |
| 0488U | Obstetrics (fetal aneuploidy), noninvasive prenatal testing, cell-free DNA analysis |
| 0489U | Obstetrics (single-gene disorders), noninvasive prenatal testing, cell-free DNA sequence analysis |
| 0490U | Oncology (cutaneous/uveal melanoma), CD146 analysis |
| 0491U | Oncology (solid tumor), circulating tumor cells, selection of estrogen receptor protein |
| 0492U | Oncology (solid tumor), circulating tumor cells, selection of PD-L1 |
| 0493U | Transplant medicine (rejection), quantitative donor-derived cell-free DNA, next-generation sequencing |
| 0494U | Red blood cell antigen (fetal RhD gene analysis), next-generation sequencing |
| 0495U | Oncology (prostate), analysis of circulating plasma protein |
| 0496U | Oncology (colorectal), cell-free DNA analysis, 8/7 genes |
| 0497U | Oncology (prostate), mRNA, real-time PCR analysis, 6 genes |
| 0498U | Oncology (colorectal), next-generation sequencing, mutation detection, 43 genes |
| 0499U | Oncology (colorectal and lung), DNA next-generation sequencing analysis, 8 genes |
| 0500U | Autoinflammatory disease (VEXAS syndrome), DNA analysis |
| 0501U | Oncology (colorectal), blood, quantitative measurement of cell-free DNA |
| 0502U | Human papillomavirus (HPV), E6/E7 markers for high-risk types, cervical cells |
| 0503U | Neurology (Alzheimer disease), beta amyloid and tau protein analysis, blood |
| 0504U | Infectious disease (urinary tract infection), identification of 17 pathogenic organisms |
| 0505U | Infectious disease (vaginal infection), identification of 32 organisms |
| 0506U | Gastroenterology (Barrett's esophagus), cell analysis, 89 biomarkers |
| 0507U | Oncology (ovarian), DNA whole genome analysis with 5-hydroxymethylcytosine |
| 0508U | Transplant medicine (rejection), donor-derived cell-free DNA analysis, 40 single nucleotide polymorphisms |
| 0509U | Transplant medicine (rejection), donor-derived cell-free DNA analysis, less than 12 single nucleotide polymorphisms |
| 0510U | Oncology (pancreatic cancer), algorithmic analysis, 16 genes |
| 0511U | Oncology (solid tumor), 3D microenvironment analysis, 36+ biomarkers |
| 0512U | Oncology (prostate), analysis of digitized images, microsatellite instability |
| 0513U | Oncology (prostate), algorithmic analysis, microsatellite instability and homologous recombination deficiency |
| 0514U | Gastroenterology (inflammatory bowel disease), immunoassay, quantitative determination of adalimumab level |
| 0515U | Gastroenterology (inflammatory bowel disease), immunoassay, quantitative determination of infliximab level |
| 0516U | Drug metabolism (pharmacogenomic), genotyping analysis, 40 genes |
| 0517U | Therapeutic drug monitoring, 80+ psychoactive drugs |
| 0518U | Therapeutic drug monitoring, 90+ pain and mental health medications |
| 0519U | Therapeutic drug monitoring, medications for pain/depression/anxiety, 110+ drugs |
| 0520U | Therapeutic drug monitoring, 200+ drugs/substances |
| 0521U | Rheumatoid factor IgA and IgM, cyclic citrullinated peptide antibodies, serum, immunoassay |
| 0522U | Connective tissue disorder, anti-PSP and anti-SP1 antibodies, qualitative/semi-quantitative |
| 0523U | Oncology (solid tumor), DNA next-generation sequencing, single nucleotide variants, 22 genes |
| 0524U | Obstetrics (preeclampsia), sFlt-1/PlGF ratio, immunoassay, serum/plasma |
| 0525U | Oncology (spheroid cell culture), 11-drug panel, ovarian/fallopian/peritoneal response prediction |
| 0526U | Nephrology (renal transplant), quantitative CXCL10 analysis |
| 0527U | HSV 1 and 2, VZV, amplified probe technique, qualitative, pathogen detection |
| 0528U | Lower respiratory tract infection, immunoassay, 18 bacterial/8 viral/7 atypical organisms, RNA detection |
| 0529U | Hematology (venous thromboembolism), single nucleotide polymorphisms, F2 and F5 genes, factor V Leiden |
| 0530U | Oncology (pan-solid tumor), circulating tumor DNA analysis, 77 genes |
| G0327 | Colorectal cancer screening; blood-based biomarker |
| G0499 | Hepatitis B screening for high-risk individuals |
2. Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services - Code Additions (2025)
This category gained 3 new training codes that address evolving care delivery models, particularly focusing on training scenarios without patient presence:
| CPT/HCPCS Code | Description |
|---|---|
| G0541 | Training without patient present, initial 30 minutes |
| G0542 | Training without patient present, each additional 15 minutes |
| G0543 | Group training without patient present |
3. Radiology and Some Other Imaging Services - Code Additions (2025)
The radiology chapter introduced 21 new codes that include artificial intelligence integration and non-invasive testing for diagnosis:
| CPT/HCPCS Code | Description |
|---|---|
| 0877T | Augmented analysis, chest CT for interstitial lung disease, without contrast |
| 0878T | Augmented analysis, chest CT for interstitial lung disease, with contrast |
| 0879T | Augmented analysis, chest CT for interstitial lung disease, preparation |
| 0880T | Augmented analysis, chest CT for interstitial lung disease, interpretation and report |
| 0889T | Personalized target development, artificial intelligence, cardiac MRI, analysis |
| 0898T | Noninvasive prostate cancer estimation map, derived from augmentative analysis of image-guided fusion biopsy and pathology |
| 0899T | Noninvasive determination of augmented quantitative myocardial blood flow, cardiac MRI |
| 0900T | Noninvasive estimation of augmented quantitative myocardial blood flow, assistive cardiac MRI |
| 0932T | Noninvasive detection of heart failure, augmented echocardiography |
| 0944T | 3D contour simulation for targeted liver lesion treatment |
| 0946T | Orthopedic implant movement analysis, paired CT imaging |
| 74263 | Computed tomographic (CT) colonography, screening, including image postprocessing |
| 75580 | Noninvasive estimation of coronary FFR, software analysis, CTA |
| 92137 | Computerized ophthalmic imaging, posterior segment, retinal thickness analysis, OCT |
| 93893 | Transcranial Doppler study, intracranial arteries, venous-arterial shunt detection |
| 93896 | Vasoreactive study, transcranial Doppler, intracranial arteries, complete |
| 93897 | Embolic detection without intravenous microbubble injection |
| 93898 | Venous-arterial shunt detection with microbubble injection |
| A9506 | Technetium Tc-99m, graphite crucible, diagnostic |
| A9610 | Xenon Xe-129, diagnostic |
| C8001 | 3D anatomical segmentation imaging, preoperative planning |
4. Radiation Therapy Services and Supplies - Code Additions (2025)
Radiation therapy services gained 5 new codes incorporating advanced treatment technologies:
| CPT/HCPCS Code | Description |
|---|---|
| 0947T | Magnetic resonance-guided focused ultrasound, stereotactic ablation, blood-brain barrier disruption |
| 51020 | Cystotomy/cystostomy with fulguration (only when includes radioactive material insertion) |
| 61715 | Magnetic resonance-guided focused ultrasound, stereotactic ablation, target intracranial |
| G0562 | Complex simulation with PET-CT fusion |
| G0563 | Stereotactic body radiation therapy with positron emission tomography delivery |
5. Preventive Screening Tests and Vaccines - Code Additions (2025)
Preventive services added 6 new codes while maintaining balanced coverage:
| CPT/HCPCS Code | Description |
|---|---|
| 74263 | Computed tomographic (CT) colonography, screening, including image postprocessing |
| 90637 | Influenza virus vaccine, quadrivalent (qIRV), mRNA; 30 mcg/0.5 mL dosage, for intramuscular use |
| 90638 | Influenza virus vaccine, quadrivalent (qIRV), mRNA; 60 mcg/0.5 mL dosage, for intramuscular use |
| 90684 | Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use |
| 90695 | Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use |
| Q0224 | Injection, pemivibart, 4500 mg |
Complete 2025 Code Deletions by Category:
Understanding which codes are being removed is equally important for maintaining compliance. Here are the complete deletion tables:
1. Clinical Laboratory Services - Code Deletions (2025)
| CPT/HCPCS Code | Description |
|---|---|
| 0204U | Oncology (thyroid), mRNA, gene expression analysis of 593 genes for sequence variants and rearrangements, utilizing fine needle aspirate |
| 0346U | Beta amyloid, Aβ40 and Aβ42 by liquid chromatography with tandem mass spectrometry, ratio, plasma |
| 0352U | Infectious disease (bacterial vaginosis and vaginitis), amplified probe technique |
| 0353U | Infectious agent detection, DNA, Chlamydia trachomatis and Neisseria gonorrhoeae, amplified probe technique |
| 0354U | Human papillomavirus (HPV), high-risk types, qualitative mRNA analysis, E6/E7 |
| 0380U | Drug metabolism (adverse drug reactions), targeted sequence analysis, 20 genes |
| 0396U | Obstetrics (preimplantation), genetic testing, 300,000 DNA markers |
| 0416U | Infectious agent detection, DNA, genitourinary pathogens, 20 bacterial and fungal organisms |
| 0428U | Oncology (breast), circulating tumor DNA analysis, 56 or more genes |
2. Physical Therapy Services - Code Deletions (2025)
| CPT/HCPCS Code | Description |
|---|---|
| 96003 | Dynamic fine wire electromyography |
3. Radiology Services - Code Deletions (2025)
| CPT/HCPCS Code | Description |
|---|---|
| 93890 | Transcranial Doppler study of the intracranial arteries; vasoreactivity study |
| C9150 | Xenon xe-129 hyperpolarized gas, diagnostic, per study dose (deleted code, replaced by A9610) |
| C9734 | Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (MR) guidance |
| C9786 | Echocardiography for coronary artery disease with heart failure preserved ejection fraction |
4. Radiation Therapy Services - Code Deletions (2025)
| CPT/HCPCS Code | Description |
|---|---|
| 64625 | Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography) |
| C9794 | Therapeutic radiology simulation-aided field setting; complex, including acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (deleted code, replaced by G0562) |
| C9795 | Stereotactic body radiation therapy with positron emission tomography delivery (deleted code, replaced by G0563) |
5. Preventive Screening Tests and Vaccines - Code Deletions (2025)
| CPT/HCPCS Code | Description |
|---|---|
| 90630 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use (deleted effective January 1, 2025) |
| 90654 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use |
| 91302 | SARS-CoV-2 vaccine, 5×10^10 viral particles/0.5 mL dosage, for intramuscular use |
| 91310 | SARS-CoV-2 vaccine, 5 mcg/0.5 mL dosage with AS03 adjuvant, for intramuscular use |
| G0106 | Colorectal cancer screening; barium enema |
| G0120 | Colorectal cancer screening; barium enema (alternative billing code) |
Comprehensive Summary of 2025 Changes:
The scope of these updates represents a fundamental shift in designated health services coverage:
| Service Category | Additions | Deletions | Net Change |
|---|---|---|---|
| Clinical Laboratory Services | 95 | 9 | 86 |
| Therapy Services (PT/OT/Speech) | 3 | 1 | 2 |
| Radiology and Imaging Services | 21 | 4 | 17 |
| Radiation Therapy Services | 5 | 3 | 2 |
| Preventive Screening & Vaccines | 6 | 6 | 0 |
| TOTAL | 130 | 23 | 107 |
Key Regulatory Changes Impacting Medical Billing:
1. Immediate Compliance Actions
- System Updates: Update all coding references, scrubbing software for claims, and monitoring tools for compliance to include the 130 new codes and eliminate the 23 deleted codes.
- Staff Training: Emphasis on detailed staff training on the 95 new clinical lab codes that constitute the largest category increase to day-to-day billing activity.
- COVID-19 Policy Updates: Revise billing for COVID-19 vaccines that are current designated health services yet remain exempt for preventive screening exceptions.
- ESRD Pharmaceutical Adjustments: From January 1, 2025, onward, composite rate payment covers all oral-only medications that are ESRD-related and deducts them from designated health service classification.
2. Technology and Innovation Implications
The inclusion of AI-supplemented diagnostic codes (0877T-0880T) is a recognition by CMS of expanding healthcare technologies. Vendors who provide AI-driven medical billing are mandated to test integration within typical workflow while maintaining regulatory compatibility.
3. Industry Impact and Regulatory Strategy
Increased laboratory and imaging codes have a significant effect on high diagnostic service practices. Healthcare billing companies that are engaged in healthcare revenue cycle management service should be ready for:
- Additional surveillance for additional designated health services
- Updated denials management service procedures
- Integrated Medical Coding Services Learning Programs
- Referral plans and financial relationships are addressed.
Moving Forward with Confidence:
2025 CMS physician self-referral modifications equate to greatest designated health services boost on record. Medical billing firms like Human Medical Billing that have strong compliance programs and a broad range of service options are best suited to guide healthcare providers on a successful trajectory amidst changes.
Increased sophistication in medical tech makes successful billing for medicine a balance between innovation and meticulous adherence to regulation. The 2025 revisions highlight that a successful practice has seasoned partners who are aware of both the technical sophistication for such changes within codes and the practical necessity for doing them.
