Coding Category III Codes
Category III codes can be found in our CPT codebooks. These use four numerical digits followed by the letter T, such as 1234T. The code set contains temporary codes used for data collection in the FDA approval process regarding new and emerging technology, services, and procedures. Codes are updated twice a year, January 1, and July 1, and are implemented six months afterwards. Updates are published on AMA’s website: www.ama-assn.org. Category III codes describe services and procedures with more specificity than Category I unlisted codes. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code.
Category III codes do not indicate the service or procedure as experimental, only that it is new and emerging and is being tracked for trending. When FDA approval is obtained for a Category III code, it becomes a Category I code. If the Category III code is not FDA approved within five years, the code is either renewed for another five years or removed from the CPT code book. Reimbursement may be available through health plans, although no RVU is assigned.
Medical practices should be aware that the AMA updates and publishes the CPT code set each year. Medical practices should use the implementation period between publications to update CPT changes in their coding and patient billing systems. If the practice contracts with a third-party vendor such as a billing service, the practice should verify that the vendor meets the update deadlines. This is not only a regulatory compliance issue; submission of outdated codes may negatively affect reimbursement and cause claim denials.
Q: True or False: If a Category III code is available, it must be reported instead of a Category I unlisted procedure code.
A: True. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code.
Reference: FY 2023 CPT Coding Book, CPT Assistant, www.ama-assn.org
