Urgent Care Billing Updates for 2026: CMS and CPT Changes Providers Must Know

The urgent care sector continues to expand rapidly as patients seek faster, more convenient, and lower-cost alternatives to emergency departments and traditional primary care. In the United States alone, urgent care facilities handled over 160 million patient visits annually, with more than 9,000 clinics operating nationwide as of 2025, reflecting sustained demand for accessible outpatient care.

Furthermore, approximately 21% of consumers reported that their most recent urgent care visit was via telehealth. This highlights the growing comfort with digital care delivery models alongside in-person visits.

Not only this but an estimated 71 million Americans (about 26 % of the population) will have used remote monitoring services by 2025. This further indicates the shift toward continuous health tracking outside traditional settings.

As this hybrid model of urgent care grows billing and coding frameworks must evolve quickly. With this transformation in mind, this blog will discuss the 2026 CMS and CPT updates every urgent care provider needs to understand.

Urgent Care Billing Updates for 2026: CMS Changes

CMS introduced several billing and payment policy updates for 2026 that directly affect urgent care reimbursement, patient financial responsibility, and telehealth operations. These changes require careful review to maintain compliance and protect revenue.

1. Medicare Physician Fee Schedule (MPFS) Final Rule

The 2026 MPFS final rule focuses on improving payment efficiency while adjusting how work effort is valued across many services commonly billed by urgent care providers.

• Efficiency Adjustment on Work RVUs

CMS implemented a 2.5% reduction to work RVUs across nearly 7,700 procedural and diagnostic codes. This adjustment lowers reimbursement for procedure-heavy services, making revenue optimization and accurate coding more important for urgent care centers.

• Conversion Factor Update

CMS increased the annual conversion factor used to calculate Medicare payments. However, the financial benefit varies by service mix, as the higher conversion factor may not fully offset the reductions from the efficiency adjustment.

1. Medicare Part B Premiums and Deductibles

Changes to Medicare Part B costs increase patient financial responsibility and affect how urgent care practices manage collections and upfront payment discussions.

• Increase in Monthly Premiums

The standard Medicare Part B premium increased to approximately $202.90 per month for 2026. As a result, higher premiums may lead patients to delay care or become more cautious about healthcare spending in urgent care settings.

• Higher Annual Deductible

The Medicare Part B deductible rose to about $283 in 2026. In fact, more visits may fall under deductible responsibility, increasing patient balances and requiring urgent care practices to collect payments earlier in the visit cycle.

1. Telehealth and Telemedicine Policy Changes

CMS refined telehealth policies to support flexibility while clearly defining supervision rules, billing eligibility, and service classification for remote care in urgent care environments.

• Permanent Direct Supervision Flexibility

CMS finalized a permanent policy allowing real-time audio and video supervision for incident-to services. This change supports flexible staffing models while ensuring supervision requirements are met for Medicare billing compliance.

• Originating Site and Facility Fee Updates

CMS updated policies governing telehealth originating sites and facility fee billing. These updates clarify when facility fees apply and help urgent care providers avoid improper reporting or missed reimbursement opportunities.

• Clarification of Telehealth Service Categories

CMS clarified that RPM and RTM services are not considered traditional telehealth services. These services remain separately billable under CPT rules when documentation, device use, and time requirements are satisfied.

Urgent Care Billing Updates for 2026: CPT Changes

CPT updates for 2026 significantly reshape how urgent care services are reported, particularly for telemedicine, remote monitoring, and emerging digital health technologies. These revisions aim to improve reporting accuracy while reflecting modern care delivery models.

1. Telemedicine CPT Code Revamp

The 2026 CPT code set introduces a new telemedicine framework to standardize reporting of virtual urgent care encounters across communication methods.

• New Evaluation and Management Telemedicine Codes

CPT introduced a new telemedicine E/M code family to distinguish visit types. Codes 98000–98007 apply to real-time audio and video visits, whereas 98008–98015 report synchronous audio-only encounters.

• Brief Virtual Check-In Code

CPT 98016 replaces prior brief check-in codes and captures short patient communications that do not meet full E/M criteria. This code supports reporting quick clinical interactions commonly handled in urgent care settings.

• Coding Impact and Payer Recognition

Although CPT released the full 98000 series, many Medicare payers currently reimburse only 98016. Coverage for additional telemedicine codes varies, so urgent care practices must closely monitor payer-specific telehealth billing policies.

• EHR and Billing System Readiness

Urgent care centers must update EHR templates, charge masters, and billing workflows before 2026. Proper system configuration ensures accurate claim submission and prevents denials due to outdated telemedicine code mappings.

1. Remote Monitoring Enhancements

CPT expanded remote monitoring codes to better reflect short-term and intermittent monitoring services commonly used in urgent care follow-ups and post-visit care coordination.

• Remote Physiologic Monitoring (RPM) Updates

New CPT 99445 reports device supply and data recording for 2–15 days, whereas 99470 captures shorter RPM treatment management time. These changes support flexible monitoring durations outside traditional monthly reporting periods.

• Remote Therapeutic Monitoring (RTM) Expansion

RTM codes now cover respiratory, musculoskeletal, and cognitive monitoring with updated descriptors. Lower interactive time thresholds and device supply options allow urgent care providers to report therapy-based monitoring more accurately.

• Improved Billing Flexibility for Short-Duration Care

The revised RPM and RTM codes allow billing for shorter or intermittent monitoring periods. This flexibility improves revenue capture for urgent care services that do not meet long-term monitoring thresholds.

1. AI-Assisted and Emerging Digital Health Codes

CPT introduced new Category III codes to support reporting of AI-assisted services increasingly used in urgent care diagnostic workflows.

• New Category III AI Codes

The 2026 CPT update includes Category III codes for AI-assisted ECG interpretation, chest imaging analysis, and prostate biopsy support. These codes reflect the growing role of artificial intelligence in clinical decision-making.

• Billing Support for Advanced Diagnostics

AI-related CPT codes help urgent care centers track and report supplemental diagnostic services. Though reimbursement varies, these codes establish standardized reporting for emerging technologies and future payment consideration.

1. Other Notable CPT Revisions

Several smaller CPT revisions impact procedural descriptions and care management reporting requirements relevant to urgent care billing accuracy.

• Procedure Code Descriptor Changes

CPT 10040 was revised from “acne surgery” to “extraction,” aligning the descriptor more closely with clinical use. An accurate understanding of revised descriptors helps prevent documentation and coding mismatches.

• RTM and RPM Time Requirement Updates

Certain care management codes now allow reporting with lower time thresholds, such as 11–20 minutes instead of 20 minutes. These updates better align coding with real-world urgent care workflows.

Outsourcing Urgent Care Billing & Coding Services

The 2026 CMS and CPT updates introduce layered changes that require more than basic billing knowledge. In fact, urgent care providers must interpret rules accurately from revised telemedicine codes to evolving reimbursement models to avoid revenue leakage. As a result, outsourcing urgent care billing and coding services to 24/7 Medical Billing Services allows providers to stay ahead of regulatory shifts without adding internal administrative burden.

24/7 MBS brings dedicated expertise in urgent care billing, continuous monitoring of payer guidance, and precise claim management tailored to new coding structures. This proactive approach strengthens compliance, improves reimbursement consistency, and gives providers the clarity needed to adapt confidently as billing requirements continue to evolve.

FAQs

Why are 2026 billing updates important for urgent care providers?

They directly affect reimbursement accuracy, compliance requirements, and revenue sustainability in a rapidly evolving care environment.

Do smaller urgent care practices face higher billing risk in 2026?

Limited internal resources can make it harder to keep up with frequent CMS and CPT updates.