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Validate HCPCS Level I Category III Code

Source: R/checks.R
is_cpt_category_III.Rd

A valid CPT Category III code is:

Usage

is_cpt_category_III(hcpcs_code)

Source

AMA Category III Codes

Arguments

hcpcs_code

<chr> string

Value

<lgl> TRUE if valid, otherwise FALSE

Details

  • 5 characters long

  • Begins with any 4 digits, [0-9]{4}, and

  • Ends with a [T]

CPT Category III codes are a set of temporary codes that allow data collection for emerging technologies and are used in the the Food and Drug Administration (FDA) approval process.

No RVUs are assigned to these codes and payment is based on payer policy. If a Category III code is available, it must be reported in place of a Category I unlisted code.

The procedure/service they describe may not meet the following Category I requirements:

  • Necessary devices/drugs have received FDA clearance/approval.

  • It is performed by many US physicians/QHPs, at a frequency consistent with intended clinical use.

  • It is consistent with current medical practice.

  • It's clinical efficacy is documented in CPT-approved literature.

Examples

x <- c('T1503', 'G0478', '81301', '69641', '0583F', '0779T', NA)

is_cpt_category_I(x)
#> [1] FALSE FALSE  TRUE  TRUE FALSE FALSE    NA

x[which(is_cpt_category_III(x))]
#> [1] "0779T"