New Category III Codes for 2014

Date: June 28, 2014

CPT contains Category III Emerging Technology codes which allow the collection of data on new services and procedures that would otherwise be treated as unlisted or miscellaneous.  Category III codes are probationary – they expire in five years if the service or procedure is not elevated to a Level 1 code through widespread adoption and recognition.

Unlike Level 1 codes, which are only published in January, the American Medical Association (AMA) releases Category III codes in both January and July by posting them on their website at www.ama-assn.org/.

The AMA released the following new Category III codes on January 1, 2014, with an implementation date of July 1, 2014.  These new codes will appear in the 2015 CPT manual.

  • 0341T  Quantitative pupillometry with interpretation and report, unilateral or bilateral
  • 0356T  Insertion of drug-eluting implant (including punctal dilation and implant removal when performed) into lacrimal canaliculus, each

Reimbursement of Category III codes is at the discretion of the payer; they are frequently considered non-covered.  The assignment of a Category III code does not mean that the service or procedure is endorsed, approved, safe or has applicability to clinical practice.  The utility of a new procedure only becomes known with experience, time and careful study.

There is no Medicare Physician Fee Schedule allowable amount for Category III codes; payment will vary even when the code is covered.

When covered, 0356T is reimbursed in a HOPD and ASC as of July 1, 2014.  ASC reimbursement for July 1 –September 30, 2014 is published as $42.81.  HOPD reimbursement for July 1 – September 30, 2014 is published as $77.49.  No facility reimbursement exists for 0341T because this is a diagnostic test.

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