2026 Evaluation and Management (E/M) Updates

The 2026 Evaluation & Management (E/M) Updates bring significant changes that impact coding accuracy, documentation integrity, and overall reimbursement across outpatient, inpatient, and specialty services. This program provides a clear, comprehensive breakdown of every major change introduced for 2026, using real‑world examples and CPT® guidance to ensure attendees walk away confident in applying the updated rules.

One of the most impactful updates is the continued shift away from history and examination as key determinants of service level. While still required when medically appropriate, these elements no longer drive code selection—placing even greater emphasis on Medical Decision Making (MDM) or total time. The program explores the nuances of this transition, including what constitutes pertinent history/exam and how to avoid under‑ or over‑documenting.

Attendees will gain detailed insight into “problems addressed,” data requirements, independent interpretation rules, and risk assessment across all MDM levels—from straightforward to high. This includes an in‑depth review of categories of data, appropriate use of independent historians, interpretation restrictions, and discussions with external providers. The presentation will also clarify appropriate documentation phrasing, such as wording required to support independent interpretation of diagnostic tests.

Important time‑based updates—including the shift from typical to minimum time and the inclusion of both face‑to‑face and non‑face‑to‑face work—are fully explained, along with updated 2024 time assignments for all codes. Additional sections will address remote physiological monitoring, treatment management codes, telehealth flexibilities, Appendix P/T changes, and updates to the conversion factor and efficiency adjustments.

Participants will leave prepared to accurately document, code, and report E/M services under the 2026 guidelines, improving compliance and supporting correct reimbursement.

This session addresses the updated E/M guidelines for 2026, focusing on documentation changes, medical decision‑making criteria, time‑based coding, and the correct application of diagnostic and management elements. Attendees will understand the problems addressed, hierarchy, data categories, risk stratification, and new telehealth and remote monitoring rules, allowing them to confidently code and document E/M services with accuracy and compliance.

• Overview of the 2026 E/M framework
• Removal of history/exam as code selection drivers
• Problems Addressed – Levels from minimal to high severity
• Data components – Categories 1, 2, and 3 explained
• Independent interpretation and documentation requirements 
• MDM risk categories – straightforward through high 
• Time‑based changes (minimum time, included activities)
• Remote physiologic monitoring & treatment management codes 
• Telehealth updates and Appendix P/T changes 
• 2026 conversion factor and efficiency adjustment impacts.

• Understand what “problems addressed” means at each MDM level
• Correctly apply data categories, including rules for independent historians 
• Document independent interpretation with required phrasing 
• Differentiate review vs. interpretation of tests 
• Accurately determine risk levels from minimal to high  
• Apply new remote monitoring and care management codes correctly 
• Incorporate updated telehealth policies into billing practices.

This program is ideal for:

• Certified medical coders
• Billing specialists and revenue cycle staff
• Practice managers and administrators
• Compliance officers
• Providers (MD/DO/NP/PA)
• Clinical documentation improvement specialists
• Auditors and consultants.