For our MAC which is NGS in Illinois, Category III codes (T codes) are not covered if there is no LCD established for them. They will also be denied for being considererd experimental procedures, not widely accepted by the medical community, not safe, etc,etc. The LCD used to deny these codes here is L25275. You may try to appeal it with the operative report and any patient specifics for medical necessity. I've also pushed back with the CPT guidelines which state that "if a Category III code is available, this code must be reported instead of a Category I unlisted code" and that "the purpose of these codes is to allow physicians and other qualified health care profesionals to identify emerging technology, services and procedures..." Good luck. Hope this helps.
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