CurrentCignaPolicy N/A

CPT Category III (T) Codes — coverage stance

Defines Cigna's coverage stance for CPT Category III (temporary 'T') codes for emerging technologies, services, and procedures; applies to services billed to Cigna-administered health benefit plans and to providers seeking reimbursement determinations.

Policy Summary

PayerCigna

PolicyCPT Category III (T) Codes — coverage stance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateAug 15, 2025

Key ActionWhen coverage depends on specific circumstances, submit the service in accordance with the applicable Coverage Policy and the customer's benefit plan document.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

manyCodes listed as not covered

multipleRelated policies

5 yearsArchival period

No changeAnnual Review

Coverage Criteria for CPT Category III (T) Codes

General policy rule: Category III codes are considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy separately addresses coverage for that code.

See Related Coverage Resources for codes specifically addressed by other policies.

Per this Cigna Coverage Policy, Category III (T) CPT codes are considered experimental, investigational, or unproven and are not covered unless a specific Cigna Coverage Policy separately addresses coverage for that particular Category III code. Refer to Related Coverage Resources for Category III codes that are addressed in other Cigna policies.

The Category III CPT codes listed in this policy are deemed experimental, investigational, or unproven (not medically necessary) for the described services and, therefore, are not covered under this policy. Examples of listed codes include, but are not limited to, 0207T, 0339T, 0559T, 0600T, 0646T, 0742T, 0947T, and 0968T with the full list and descriptions provided in the Coding section of this policy.

Code Listings and Coding Guidance

Related/Addressed Category III Codes (covered in other Cigna policies)CPT

0650T	Ambulatory External and Implantable Electrocardiographic Monitoring (listed as addressed in related policy)
0591T	Behavioral Health Coaching and Peer Support Services
0592T	Behavioral Health Coaching and Peer Support Services
0537T	Brexucabtagene autoleucel / Idecabtagene vicleucel / Lisocabtagene maraleucel / Tisagenlecleucel / Yescarta (grouped across related policies)
0538T	See 0537T group
0539T	See 0537T group
0540T	See 0537T group
0042T	eviCore Adult Head Imaging guideline
0501T	eviCore Pediatric Cardiac Imaging guideline
0502T	eviCore Pediatric Cardiac Imaging guideline

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Category III Codes Considered Experimental/Investigational/UnprovenCPTNot Covered

0207T	Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral
0339T	Transcatheter renal sympathetic denervation, percutaneous
0342T	Therapeutic apheresis with selective HDL delipidation and plasma reinfusion
0351T	Optical coherence tomography of breast or axillary lymph node, excised tissue, each specimen; real-time intraoperative
0439T	Myocardial contrast perfusion echocardiography; at rest or with stress
0442T	Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve
0489T	Autologous adipose-derived regenerative cell therapy for scleroderma in the hands
0511T	Removal and reinsertion of sinus tarsi implant
0525T	Insertion or replacement of intracardiac ischemia monitoring system; complete system
0546T	Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy

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Archival period for Category III codes — inv-06

Archival periodCategory III (T) codes are generally archived after five years.

Purpose of archivingArchiving follows the data-collection period to determine whether a Category I CPT code should be established.

Post-archival reportingIf no Category I cross-reference exists at archiving, the service is reported with a Category I unlisted code.

Implication for coverageArchived status does not imply established clinical efficacy or standard of care.

Provider Requirements and Billing Instructions

Prior Authorization

Prior authorization / coverage requirements

When coverage depends on specific circumstances, reimbursement will be provided only if the requested service is submitted in accordance with the relevant criteria in the applicable Coverage Policy and the terms of the member's benefit plan.

Reimbursement is allowed only when billed with covered diagnosis and/or procedure code(s) as specified in the Coverage Policy.
Coverage determinations require review of the applicable benefit plan in effect on the date of service, applicable laws/regulations, relevant collateral materials (including Coverage Policies), and the specific facts of the request.

Documentation Required

Provider action required

Providers should follow any provider-action steps required by the member's plan or Coverage Policy when submitting requests or claims.

Medical directors have discretion to use clinical judgment in individual determinations.
Each coverage request should be reviewed on its own merits.

Billing Rule

Coding and submission

Providers must use the most appropriate diagnosis and procedure codes that are valid as of the effective date of the submission.

Use current codes on the date of service/submission.
Claims submitted without covered code(s) under the applicable Coverage Policy will be denied as not covered.

Denial Risk

Billing with non‑covered codes

Claims for services not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.

Reimbursement is not provided for services billed for conditions or diagnoses that are not covered by the Coverage Policy.
In the event of conflict, the customer's benefit plan document supersedes the Coverage Policy.

Background

CPT Category III codes are temporary, four-digit codes followed by a trailing 'T' that are assigned to emerging technologies, services, and procedures for the purpose of data collection to document clinical efficacy and support potential future Category I code development. These codes do not, by their presence, indicate established clinical efficacy or standard of care. Category III codes are generally archived after approximately 5 years, and because of their data-collection purpose, the services they represent are considered experimental, investigational, or unproven unless specifically addressed by a separate Cigna Coverage Policy.

Definitions

Category III (T) codes — inv-12

DefinitionCPT Category III codes are temporary 'T' codes: four digits followed by the letter T, assigned to emerging technologies, services, and procedures for data collection.

Primary purposeUsed for data collection to document clinical efficacy, utilization, and outcomes and to support FDA processes.

IdentificationIdentified by an alpha 'T' character as the 5th character in the code string (four digits + 'T').

Coverage implicationUnless a specific Cigna Coverage Policy addresses a Category III code, it is generally considered experimental, investigational, or unproven and not covered.

Alternate termAlso referred to as 'T Codes' by the AMA.