The 2025 update to the Current Procedural Terminology^[i] (CPT)^® has 270 new codes, 38 revised codes, and 112 deleted codes. In addition, the ICD-10-CM^[ii] update has over 300 revisions, additions and deletions. Although relatively few of these changes will impact radiology practices, it’s essential to know what they are and adjust your practice systems accordingly.

Diagnostic Radiology

MRI Safety

A new CPT subsection has been established for reporting six new codes describing MR safety services, including implant or foreign body evaluation, safety consultation, electronics preparation, and implant positioning or immobilization. The new Magnetic Resonance (MR) Safety Implant/Foreign Body Procedures of the Radiology/Diagnostic Radiology (Diagnostic Imaging) subsection of the CPT code book contains the codes and the guidelines for reporting them. These new codes describe the work that takes place prior to an MRI study that includes the proper assessment, consultation, and medical physics customization for patients who have an implant, device, or foreign body.

The new MRI Safety procedures are as follows:

Note: G = Global, PC = Professional Component.
Medicare Fee represents the national level using the CF of $32.3465 in effect as of this writing.

Note that 76014 and 76015 are technical component codes that reflect the work of an MRI technologist and/or a medical physicist. They do not include any physician work value, but they would be available in the imaging center using global billing.

MRI-Monitored Transurethral Ultrasound Ablation (TULSA)

MRI-monitored TULSA utilizes robotically driven directional thermal ultrasound and closed loop temperature feedback control software to deliver predictable physician-prescribed ablation of prostate tissue for treatment of prostate cancer. The following codes are available for reporting this procedure.  

MRI-Guided High Intensity Focused Ultrasound (MRgFUS)

The existing Category III^[iii] code 0398T MRI-guided high intensity focused ultrasound, stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed will be deleted and replaced by these three new Category I codes.

These codes are designed to capture the comprehensive components of the MRgFUS procedure, including treatment planning, probe insertion, and the ablation process. This update reflects the procedure's established clinical use and is expected to facilitate broader adoption in treating conditions such as intracranial movement disorders.

Transcranial Doppler

Three new add-on codes will be available to report procedures performed along with CPT Code 93886 Transcranial Doppler study of intracranial arteries, complete.

Code 93893 Transcranial Doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection has been revised to describe venous-arterial shunt detection and code 93890 Transcranial Doppler study of the intracranial arteries; vasoreactivity study has been deleted.

The Cerebrovascular Arterial Studies guidelines will be revised to clarify when the existing transcranial Doppler study codes 93886, 93888, 93892, and 93893 and the new add-on codes are to be reported.

Interventional Radiology

Percutaneous RF Ablation of Thyroid

There have been no CPT codes to report RF ablation of the thyroid under imaging guidance. Category III code 0673T had been used for ablation of benign thyroid nodules.  Beginning in 2025, there is a new code to report percutaneous radiofrequency ablation of thyroid plus an add-on code to report ablation of additional nodule(s).

Fascial Plane Blocks (FPB)

Six new codes have been created to report specific fascial plane block infiltration (injection or infusion) of the thoracic, lower extremity, and abdominal regions in post-operative pain management.

Codes 64486-64489 will be editorially revised to specify reporting of Transversus abdominis plane (TAP) block, and the guidelines in the Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Somatic Nerves will also be revised to reflect these changes.

Vascular Procedures Guidelines

Guidelines in the Vascular Procedures subsection of the Radiology section will be revised to clarify that add-on code 75774, Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure), may be reported for both arteries and veins for each additional vessel. The cross-reference parenthetical notes following code 75774 that direct users to codes 75600-75756 (angiography) and 36215-36248 (catheterization) will be deleted.

Evaluation & Management  

Telemedicine Office Visits

17 new telemedicine codes and guidelines will be added to a new Evaluation and Management (E/M) subsection for Telemedicine Services within the E/M Office Visits or Other Outpatient Services subsection of the CPT code book. Medicare has not yet recognized these new codes, although other payers might possibly reimburse them. The new codes allow reporting of the work involved with telemedicine (audio-visual and audio-only) office visits and will be structured like the current office and other outpatient E/M codes (four levels depending on medical decision making or time, as well as separate codes for new and established patients).

Codes 99441, 99442, 99443 describing telephone evaluation and management services will be deleted.

Category III Codes

For 2025 several new Category III codes related to radiology practice will be available, as follows:

Diagnosis Coding 

The following ICD-10 code changes are relevant to radiologists:

Anal, Rectal, and Anorectal Fistulas

New 5th and 6th character codes provide greater specificity, distinguishing between simple and complex cases, and identifying initial, persistent, or recurrent conditions. Detailed documentation of these aspects is essential for accurate coding.

• K60.30 - Anal fistula, unspecified
• K60.31 - Anal fistula, simple
• K60.32 - Anal fistula, complex
• K60.33 - Anal fistula, persistent
• K60.34 - Anal fistula, recurrent 

Pulmonary Embolism

Expanded codes now specify causes, including cement or fat embolism, enhancing the precision of radiological reporting.

• I26.92 - Other pulmonary embolism without acute cor pulmonale
• I26.93 - Other pulmonary embolism with acute cor pulmonale 

Synovitis and Tenosynovitis

Additional codes allow for precise location specification of unspecified synovitis and tenosynovitis, aiding in detailed imaging reports.

• M65.871 - Other synovitis and tenosynovitis, right ankle and foot
• M65.872 - Other synovitis and tenosynovitis, left ankle and foot
• M65.879 - Other synovitis and tenosynovitis, unspecified ankle and foot

Lymphoma

Updates offer further specificity in types of lymphoma and include expanded codes to identify cases in remission, which is crucial for imaging follow-ups.

• C83.33 - Diffuse large B-cell lymphoma, intrathoracic lymph nodes
• C83.36 - Diffuse large B-cell lymphoma, intrapelvic lymph nodes
• C85.88 - Other specified types of non-Hodgkin lymphoma, other sites 

Hypoglycemia and Obesity

Both conditions are now categorized into levels 1-3, necessitating detailed documentation to support appropriate imaging studies.

• E16.3 - Other specified hypoglycemia
• E66.01 - Morbid (severe) obesity due to excess calories
• E66.09 - Other obesity due to excess calories

Breast Cancer Biomarkers

New Z codes indicate PR and HER-2 status, to be used alongside breast cancer diagnoses, facilitating tailored imaging protocols.

• Z85.850 - Personal history of malignant neoplasm of breast
• Z17.0 - Estrogen receptor positive status [ER+]
• Z17.1 - Estrogen receptor negative status [ER-]
• Z17.2 - Progesterone receptor positive status [PR+]
• Z17.3 - Progesterone receptor negative status [PR-]
• Z17.4 - HER-2 positive status 

Personal History of Colon Polyps

Expanded codes specify adenomatous/serrated, hyperplastic, or other types of colon polyps, important for imaging surveillance strategies.

• Z86.010 - Personal history of adenomatous polyps of colon
• Z86.011 - Personal history of hyperplastic polyps of colon
• Z86.012 - Personal history of other specified polyps of colon

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[i] Current Procedural Terminology is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

[ii] ICD stands for International Classification of Diseases, the system owned and copyrighted by the World Health Organization that is used to report diagnoses when submitting claims for reimbursement of physician services, among many other purposes. ICD-10 is the 10th edition of this coding system. CM stands for the Clinical Modification of the classification system.

[iii] Category III codes are temporary codes that allow for data collection for emerging technologies, services, procedures, and service paradigms.   They are not routinely reimbursed by most payers, including Medicare, when they are initially issued but that can change as they become more accepted and eventually transitioned into a Category I classification with regular reimbursement.

Erin Stephens, CPC, CIRCC  is the Sr. Client Manager, Education at Healthcare Administrative Partners. 

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