CPT Category III codes are a set of temporary codes that allow data collection for emerging technologies, services, procedures, and service paradigms.
Usage
is_category_III(x, arg = rlang::caller_arg(x), call = rlang::caller_env())Arguments
- x
<chr>string oflength(1)- arg
<chr>function argument name in the current function- call
<environment>environment the function is called from
Details
These codes are intended to be used for data collection to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process.
CPT Category III codes may not conform to one or more of the following CPT Category I code requirements:
All devices and drugs necessary for performance of the procedure or service have received FDA clearance or approval when such is required for performance of the procedure or service.
The procedure or service is performed by many physicians or other qualified health care professionals across the United States.
The procedure or service is performed with frequency consistent with the intended clinical use (i.e., a service for a common condition should have high volume, whereas a service commonly performed for a rare condition may have low volume).
The procedure or service is consistent with current medical practice.
The clinical efficacy of the procedure or service is documented in literature that meets the requirements set forth in the CPT code change application.
Category III codes are not developed as a result of Panel review of an incomplete proposal, the need for more information, or a lack of CPT Advisory Committee support of a code-change application.
CPT Category III codes are not referred to the AMA-Specialty RVS Update Committee (RUC) for valuation because no relative value units (RVUs) are assigned to these codes. Payments for these services or procedures are based on the policies of payers and not on a yearly fee schedule.
Category III codes allow data collection for these services or procedures, unlike the use of unlisted codes, which 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 Category III codes allows physicians and other qualified health care professionals, insurers, health services researchers, and health policy experts to identify emerging technologies, services, procedures, and service paradigms for clinical efficacy, utilization, and outcomes.
These codes have an alpha character as the 5th character in the string (i.e., four digits followed by the letter T). The digits are not intended to reflect the placement of the code in the Category I section of CPT nomenclature.
Codes in this section may or may not eventually receive a Category I CPT code. In either case, in general, a given Category III code will be archived five years from the initial publication or extension unless a modification of the archival date is specifically noted at the time of a revision or change to a code (e.g., addition of parenthetical, instructions, reinstatement).
Services and procedures described by Category III codes which have been archived after five years, without conversion, must be reported using the Category I unlisted code unless another specific cross-reference is established at the time of archiving.