New Category III Code

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 code on July 1, 2015, with an implementation date of January 1, 2016.  This new code will appear in the 2016 CPT manual. 

• 0402T        Collagen cross-linking of cornea (including removal of the corneal epithelium and intraoperative pachymetry when performed)

                        (Do not report 0402T in conjunction with 65435, 69990, 76514)

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.