New Category III Codes Provide a Window Into the Future of Medicine
- By Renee Dustman
- In Coding
- February 2, 2023
- 2 Comments
Wondering what the future holds for healthcare? Just scan through the CPT® Category III codes.
The CPT® Editorial Panel recently released 20 new Category III codes for emerging technologies, procedures, services, and service standards. The codes go into effect July 1, but you won’t find them in your 2023 code book. In accordance with the American Medical Association’s Category III code semi-annual early release schedule, the codes will debut in CPT® 2024.
Understand the Purpose of Category III Codes
Most new tech starts in the Category III section of CPT® as purely informational and noncovered by health plans in terms of reimbursement. The resulting data these codes generate can be used by stakeholders to track adoption of the new tech and perhaps aid in getting approval by the Food and Drug Administration — something a code needs before it can go on to become a Category I code that payers may add to their lists of covered benefits.
Become Acquainted With Emerging Technologies
The 20 new Category III codes, +0791T – 0810T, describe various medical innovations. For example, add-on code +0791T describes motor-cognitive, semi-immersive virtual reality-facilitated gait training. “Virtual reality-based cognitive training (VRCT) combined with locomotor activity can be used as a simultaneous intervention for cognitive rehabilitation and functional capacity improvement in older adults,” according to a published article in the National Library of Medicine. The article continues, “With the advancements in information technology, virtual reality (VR)-based cognitive rehabilitation therapy and VR games as resources for helping improve deteriorated functional capacity have modernized the clinical practice of rehabilitation professionals.”
The rest of the new codes, released Dec. 29, 2022, describe emerging technology, procedures, services, and service protocols such as percutaneous transcatheter thermal ablation (0793T), pharmaco-oncologic algorithmic treatment ranking (0794T), and dual-chamber leadless pacemaker (0795T-0804T). Codes 0805T and 0806T report transcatheter superior and inferior vena cava prosthetic valve implantation. CPT® gives very specific guidelines for which diagnostic right and left heart catheterization codes you can and cannot use with these new codes, come July 1.
Pay Attention to Existing Category III Code Revisions
Also, effective July 1, Category III code 0632T Percutaneous transcatheter ultrasound ablation of nerves … will have a new parenthetical note instructing you to use 0793T for “percutaneous transcatheter thermal ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all image guidance.” There is also a guideline change for 0775T: For percutaneous arthrodesis of the sacroiliac joint using both a transfixation device and intra-articular implant(s), CPT® instructs you to use 0809T beginning July 1, instead of Category I code 27299 Unlisted procedure, pelvis or hip joint. Pay close attention to payer policies to see how they handle this guideline change.
UPDATE: Starting April 1, 2023, prior authorization for most CPT® III codes, also known as T codes, will be required for UnitedHealthcare Oxford and UnitedHealthcare West plan members.
Hwang NK, Choi JB, Choi DK, Park JM, Hong CW, Park JS, Yoon TH. Effects of Semi-Immersive Virtual Reality-Based Cognitive Training Combined with Locomotor Activity on Cognitive Function and Gait Ability in Community-Dwelling Older Adults. Healthcare (Basel). 2021 Jun 28;9(7):814. doi: 10.3390/healthcare9070814. PMID: 34203233; PMCID: PMC8305308.
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When billing for a Category III code, how does a practice go about establishing a reimbursement rate since there are no RVU’s assigned yet to the code.
Payments for these services or procedures are based on the policies of payers and not on a yearly fee schedule.