AMA CPT® Assistant - 2012 Issue 1 (January)

Category III Codes (Q&A) (January 2012)

January 2012 pages 13-14 Category III Codes Question: A payer in my area says that assignment of a CPT Category III code status to a service indicates that the procedure or service is "experimental/investigational" and as such is not eligible for coverage. They broadly deny coverage for all CPT Category III codes on this basis. Is it correct to say that the assignment of a CPT Category III code to a procedure or service means that it is experimental/investigational and ineligible for coverage and payment or would it be more appropriate for the insurer to view all of the...

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CPT® Assistant content is the official source for CPT® coding guidance. It is an instrumental tool when appealing insurance denials and validating coding to auditors. Monthly issues and an extensive archive provide comprehensive guidance on proper CPT® coding for past, present and upcoming code set releases. Archives date back to 1990 for historical use of codes, changes, rationales, coding tips and trends in the industry.

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