Category III Codes

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May 1, 2015 - usual requirements for CPT Category I codes established by the Editorial Panel. For Category I codes, the
Category III Codes

Effective: May 1, 2015 Description: Category III codes allow data collection for emerging technology, services and procedures. Use of unlisted codes does not offer the opportunity for the collection of specific data. If a Category III code is available, this code must be reported instead of a Category I unlisted code. This is an activity that is critically important in the evaluation of health care delivery and the formation of public and private policy. The use of the Category III codes allow physicians and other qualified health care professionals, insurers, health services, researchers and health policy experts to identify emerging technology, services and procedures for clinical efficacy, utilization and outcomes. The services or procedures associated to the Category III codes neither implies nor endorses clinical efficacy, safety or the applicability to clinical practice. The codes may not conform to the usual requirements for CPT Category I codes established by the Editorial Panel. For Category I codes, the Panel requires that the service/procedure be performed by many care professionals in clinical practice in multiple locations and that FDA approval, as appropriate, has already been received. The nature of emerging technology, services, and procedures is such that these requirements may not be met. Category III codes represent emerging technology services that may not be FDA approved or have not been performed by many health care professionals in clinical practice. The use of these codes is unproven due to insufficient clinical evidence of safety and/or efficacy in published peer reviewed medical literature. Refer to the individual medical policy for the following Category III codes: Procedure Code(s) 0019T , 0101T, 0102T, 0299T, 0300T 0048T, 0052T, 0053T 0054, 0055T 0073T 0075T, 0076T 0092T, 0095T, 0098T, 0163T, 0164T, 0165T 0099T 0126T

Medical Policy Policy III.150 – Extracorporeal Shock Wave Therapy Policy III.109 – Ventricular Assist Devices and Total Artificial Hearts Policy III.182 – Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure Policy IV.72 – IMRT Policy III.137 – Carotid Angioplasty/Stenting Policy III.170 – Artificial Intervertebral Discs Policy III.172 – Implantation of Intrastromal Corneal Ring Segments Policy IV.73 – Ultrasonographic Measurement of Intimal Medial

0159T 0182T 0198T 0223T, 0224T, 0225T, 0295T, 0296T, 0297T, 0298T 0282T, 0283T, 0284T, 0285T, 0312T, 0313T, 0314T, 0315T, 0316T, 0317T 0333T 0336T

0340T 0355T

Thickness as an Assessment of Subclinical Atherosclerosis Policy IV.58 – Magnetic Resonance Imaging of the Breast Policy IV.76 – Accelerated Irradiation, Brachytherapy and Intraoperative Radiation Therapy Policy IV.51 – Ophthalmologic Techniques of Evaluating Glaucoma Policy I.155 – Cardiac Event Monitors and Outpatient Cardiac Telemetry Policy III.105 – Electrical Stimulation of Muscles and Nerves Policy III.125 – Monitoring of Sensory Evoked Potentials Policy III.105 – Procedures to Treat Dysmenorrhea and Uterine Fibroids Including: Uterine Nerve Ablation, Presacralneurectomy (LUNA), Laparoscopic and Percutaneous Techniques for the Myolysis of Uterine Fibroids Policy III.145 – Radiofrequency and Cryosurgical Ablation of Solid Tumors Policy I.139 – Wireless Capsule Endoscopy in Obscure Digestive Tract Bleeding

Note: BCBSNE considers all other Category III codes not listed above as Investigative.