CPT code updates in 2026 will change how interventional cardiologists get paid

Seto noted that reimbursement gaps have hindered the adoption of proven technologies in the past. He pointed to things like invasive fractional flow reserve (FFR) physiologic assessment, intravascular imaging and, more recently, renal denervation.

“So many times, we've seen things that are not reimbursed, that don't end up panning out or flying,” he said,  The new initiative, he added, aims to emphasize the “practical elements of physician practice reimbursement, the regulation and the research.”

CPT codes, a set of five-digit medical codes maintained by the American Medical Association (AMA), are used to identify medical services and procedures. These codes are used for billing, insurance claims and communication among healthcare professionals.

New complex PCI code: 92930

Among the most impactful changes is the creation of a new complex PCI category. Seto explained that the longstanding 92928 code did not account for additional work involved in bifurcation lesions or multiple lesions in the same vessel.

“In 2026, the proposed CPT changes created a new category of complex PCI,” he said. “So instead of the standard 92928 code for simple PCI … we now have a new code 92930, which actually gives you 20% more RVU credits.”

However, he emphasized that physicians must meet specific criteria to use the code. 

“We have to actually use two different stents separated, not overlapped,” he said. “You actually have to treat the side branch with angioplasty or stenting; just wiring it and protecting it is not enough.”

Major expansion of peripheral vascular codes

Significant changes are also coming to peripheral vascular coding, moving from just 16 peripheral and lower extremity vascularization codes to 46.

“They vastly expanded the specificity of the lower extremity revascularization code set,” Seto said.

A new category has been created for inframalleolar, tibial, peroneal and foot interventions, an area of high clinical need. While overall reimbursement remains similar, the codes better define what is being done in procedure with more specific codes.

“Now you have a lot more specificity,” Seto said. “You have to update all of your coding systems and educate all your coders to ensure that you have the optimal reimbursement for your practice.”

Seto confirmed these new codes also introduce more granular payment differentiation. The additional codes include different payment rates and better define simple vs. complex peripheral interventions.

The broader debate over RVUs and physician work

Beyond coding updates, Seto addressed systemic concerns about the RVU-based reimbursement model. He pointed to the new reimbursement threat of the 2.5% efficiency adjustment included in the 2026 Medicare Physician Fee Schedule that reduces reimbursement across all codes annually. SCAI's position is that this efficiency adjustment is primarily a new way to take money away from physicians by saying they are using new technology and experience to become faster at clinical tasks. This is a break from the traditional process where physicians with the AMA decide on how to value clinical tasks and assign RVUs that Medicare then uses for billing.

“It really raises the question of whether the RVU system is really going to continue being the gold standard,” he said.

He noted that the structure of RVUs can disadvantage procedural specialties and make it less profitable to perform complex procedures, when the same amount of money or more can be made performing simpler or more efficient tasks.

“The reality is that reading an echo can be very efficient. You can actually make more money reading four echos than you can doing a diagnostic cath,” Seto explained. “From the interventional cardiology standpoint, it really impacts us because the value of our procedural work and our expertise has been reduced over time.”

While primary care increases are justified, he said, they should not come at the expense of procedural fields. “That’s our bread and butter,” Seto explained. “We do have to advocate for having fair and adequate reimbursement.”

Seto stressed that the RVU system works only if physicians continue to lead it. He warned that alternatives could be far worse.

“If the doctors aren't in charge or at least guiding the process, who is?" Seto asked. 

As SCAI’s advocacy chair, Seto said the society supports RVU reform, but cautions against scrapping the system without a viable replacement. 

“We really don't want to throw it away without any alternative coming down the pike,” he said. “Because the alternatives, frankly look quite a bit worse.”