CurrentCignaPolicy 0558

Medical Coverage Policy

Defines Cigna's coverage stance for CPT Category III (temporary 'T') codes: generally considers Category III codes experimental, investigational, or unproven unless a specific Cigna Coverage Policy addresses a particular T code and provides coverage criteria. Includes a long list of Category III codes considered experimental/investigational/unproven and cross-references Related Coverage Resources where select T codes may be covered for specific indications.

Policy Summary

PayerCigna

PolicyMedical Coverage Policy

Policy CodePolicy 0558

Change TypeClarified / Reviewed

Effective DateApr 15, 2026

Next Review DateAug 15, 2026

Key ActionWhen a Category III code is billed, verify if a specific Cigna Coverage Policy or Related Coverage Resource addresses that particular code and follow that policy's medical necessity criteria and documentation requirements.

SourceLink

POLICY UPDATE CHANGES

Revision Details indicate multiple focused and annual reviews with 'No clinical policy statement changes' for several dates and one entry 'Revised policy statement' on 12/15/2024.

~90+Category III codes listed

15Related policies listing covered T codes

1Primary coverage stance (experimental unless specified)

Coverage Summary

Defines Cigna's coverage stance for CPT Category III (temporary 'T') codes: Category III codes are generally considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy explicitly addresses and extends coverage to a particular Category III code. The policy effective date is 2026-04-15, last review 2025-10-15, and next review 2026-08-15.

Unless a specific Cigna Coverage Policy addresses a particular Category III code, Category III codes are considered experimental, investigational, or unproven. Where a Related Coverage Policy specifically extends coverage to a particular Category III code, that policy's criteria govern coverage; claims billed without covered diagnosis and/or procedure codes under the applicable Coverage Policy will be denied as not covered.

Policy metadata

PayerCigna

PolicyMedical Coverage Policy

Policy Number0558

Effective Date2026-04-15

Last Review

Medical Necessity / Criteria

General Coverage Position

Unless a specific Cigna Coverage Policy addresses a particular Category III code, Category III codes are considered experimental, investigational, or unproven.

ALL of the following

CPT Category III codes are temporary codes intended for data collection and represent emerging technologies, services, and procedures.
Items, services or procedures represented by Category III codes are considered experimental, investigational or unproven unless coverage for a particular Category III code is separately addressed in a Cigna Coverage Policy.
Where a Related Coverage Policy specifically extends coverage to a particular Category III code, that policy's criteria govern coverage.
Claims billed without covered diagnosis and/or procedure codes under the applicable Coverage Policy will be denied as not covered.

CPT Category III Codes

Considered Experimental/Investigational/Unproven (listed Category III codes)CPTExperimental

0207T	Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral.
0338T	Transcatheter renal sympathetic denervation, percutaneous approach; unilateral.
0339T	Transcatheter renal sympathetic denervation, percutaneous approach; bilateral.
0342T	Therapeutic apheresis with selective HDL delipidation and plasma reinfusion.
0351T	Optical coherence tomography of excised breast or axillary lymph node tissue; real-time intraoperative.
0439T	Myocardial contrast perfusion echocardiography; at rest or with stress.
0489T	Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; harvesting, isolation and preparation.
0525T	Insertion or replacement of intracardiac ischemia monitoring system; complete system.
0546T	Radiofrequency spectroscopy, real time, intraoperative margin assessment at time of partial mastectomy.
0559T	Anatomic model 3D-printed from image data set(s); first individually prepared and processed component.

1–10 of 56

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Cross-referenced Category III codes potentially covered per related policiesCPTCovered

0650T	Ambulatory external and implantable electrocardiographic monitoring.
0591T	Behavioral Health Coaching and Peer Support Services.
0592T	Behavioral Health Coaching and Peer Support Services.
0537T	CAR-T related (cross-referenced policies).
0538T	CAR-T related (cross-referenced policies).
0539T	CAR-T related (cross-referenced policies).
0540T	CAR-T related (cross-referenced policies).
0446T	Diabetes equipment/supplies (cross-referenced policies).
0447T	Diabetes equipment/supplies (cross-referenced policies).
0448T	Diabetes equipment/supplies (cross-referenced policies).

1–10 of 28

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Provider Actions & Billing Guidance

Documentation Required

Use applicable coverage policy or related policy

When a Category III code is billed, verify if a specific Cigna Coverage Policy or Related Coverage Resource addresses that particular code; if so, follow that policy's medical necessity criteria and documentation requirements.

Billing Rule

Claims with non-covered codes will be denied

Claims submitted for services that are not accompanied by covered diagnosis and/or procedure codes under the applicable Coverage Policy will be denied as not covered.

Background and Definitions

CPT Category III codes are temporary (four digits followed by the letter 'T') codes assigned to emerging technologies, services, and procedures and are intended primarily for data collection to support evaluation of clinical efficacy, utilization, and outcomes. Because of this data-collection purpose and typically limited published peer-reviewed evidence, items, services, or procedures represented by Category III codes are generally considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy separately addresses and provides coverage for that particular Category III code.

Some Category III codes may be considered medically necessary for certain indications when covered by related Cigna policies listed under Related Coverage Resources; otherwise, Category III codes are typically archived after about five years and may convert to Category I or be reported with unlisted codes if no Category I cross-reference exists.

CPT Category III (T) Codes: Temporary CPT codes (four digits followed by 'T') assigned to emerging technologies, services, and procedures for data collection.

Revision History

12/15/2024revision

Focused Review — Revised policy statement.

2/15/2025review

Focused Review — No clinical policy statement changes.

4/15/2025review

Focused Review — No clinical policy statement changes.

Policy Summary

PayerCigna

PolicyMedical Coverage Policy

Policy CodePolicy 0558

Change TypeClarified / Reviewed

Effective DateApr 15, 2026

Next Review DateAug 15, 2026

SourceLink

On This Page

OpenPayer

Related Billing Codes

Medical Coverage Policy

Coverage Summary

Medical Necessity / Criteria

CPT Category III Codes

Provider Actions & Billing Guidance

Background and Definitions

Revision History