CurrentCignaPolicy 0558

Medical Coverage Policy

Defines Cigna's coverage position for CPT Category III (temporary 'T') codes: by default Category III codes are considered experimental/investigational/unproven unless a specific Cigna Coverage Policy for a particular Category III code provides coverage. Lists numerous Category III codes considered experimental/investigational/unproven and references related policies that may consider some Category III codes medically necessary for specified indications.

Policy Summary

PayerCigna

PolicyMedical Coverage Policy

Policy CodePolicy 0558

Change TypeClarified; Revised

Effective DateApr 15, 2026

Next Review DateAug 15, 2026

Key ActionUse appropriate codes and supporting documentation: submit claims with the most appropriate codes as of the date of service and include documentation to support medical necessity; claims billed with Category III codes will be denied if not accompanied by covered diagnosis/procedure codes consistent with the applicable Coverage Policy.

SourceLink

POLICY UPDATE CHANGES

Policy reiterates that Category III codes are considered experimental/investigational/unproven unless a specific Cigna Coverage Policy provides coverage.

Revision history entries note multiple focused and annual reviews with no clinical policy statement changes for several dates.

~80Category III codes listed

MultipleRelated coverage policies

DenyDefault coverage stance

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Coverage Summary

Scope: This policy defines Cigna’s coverage position for CPT Category III (temporary 'T') codes. By default, Category III codes are considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy explicitly provides coverage for a particular Category III code.

Brief overview: CPT Category III codes are temporary codes for emerging technologies, services, and procedures used primarily for data collection; they may be considered medically appropriate only when a specific Cigna Coverage Policy explicitly extends coverage to that code. Refer to Related Coverage Resources for Category III codes that may be addressed as medically necessary in other Cigna policies.

Policy metadata

Policy titleCPT Category III (T) Codes coverage policy

PayerCigna Companies

Policy number0558

Effective date2026-04-15

Last review2025-10-15

Next review2026-08-15

Default coverage stanceDefault deny (Category III codes considered experimental/investigational/unproven unless a specific Cigna policy provides coverage)

Medical-Necessity Criteria

General Coverage Position

Category III codes are temporary codes for emerging technologies and are considered experimental/investigational/unproven unless covered by a specific Cigna policy.

CPT Category III (T) codes are considered experimental, investigational or unproven by default.
A Category III code may be considered medically appropriate only if a specific Cigna Coverage Policy explicitly extends coverage to that code.
Refer to Related Coverage Resources for Category III codes that are addressed as medically necessary in other Cigna policies.

Exception / Related Policies

Coverage exceptions exist where related Cigna Coverage Policies specifically address certain Category III codes as medically necessary.

ANY of the following related policies may cover specific Category III codes

Coding (Category III CPT Codes)

Considered Experimental/Investigational/Unproven (Category III T codes listed in policy)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 breast or axillary lymph node, excised tissue, each specimen; 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; adipose tissue harvesting, isolation and preparation...
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, with report.
0559T	Anatomic model 3D-printed from image data set(s); first individually prepared and processed component.

1–10 of 56

1/6

Category III (temporary 'T') CPT codes are assigned for emerging technologies, services, and procedures primarily to support data collection. These temporary codes are typically maintained for about five years and may be archived after five years. If a Category III code is archived and no cross-referenced Category I code exists, the service or procedure may be reported using an appropriate Category I unlisted code, or the procedure may later convert to a Category I code if sufficient evidence supports such a change.

Provider Actions / Billing Guidance

Documentation Required

Use appropriate codes and supporting documentation

Submit claims using the most appropriate codes as of the date of service and include documentation to support medical necessity. Claims for services billed with Category III codes will be denied if not accompanied by covered diagnosis/procedure codes consistent with the applicable Coverage Policy.

Use the most appropriate codes as of the date of service.
Include documentation to support medical necessity.
Claims for Category III codes will be denied if not accompanied by covered diagnosis/procedure codes consistent with the applicable Coverage Policy.

Prior Authorization

Prior authorization / specific policy requirement

If a specific Category III code is addressed as covered by a related Cigna Coverage Policy, providers must follow that policy's prior authorization and utilization review requirements. See the Related Coverage Resources for policies that may cover particular Category III codes.

Background

CPT Category III codes are temporary codes intended to identify emerging technologies, services, and procedures for data collection; because of their purpose, there is typically limited published, peer-reviewed evidence supporting their clinical efficacy, safety, or applicability, and they are generally considered experimental/investigational/unproven unless specifically covered.

Exception approach: Coverage exceptions exist when a related Cigna Coverage Policy specifically addresses a given Category III code and considers it medically necessary for defined indications. The policy references multiple related coverage resources that may cover specific Category III codes (for example: Ambulatory External and Implantable Electrocardiographic Monitoring — 0650T; Behavioral Health Coaching and Peer Support Services — 0591T, 0592T; Brexucabtagene autoleucel/CAR-T related codes — 0537T–0540T; Diabetes Equipment and Supplies — 0446T–0448T). See the Related Coverage Resources/criteria group for the full list of policies and codes that may be covered.

Definitions

Category III (T) codes: Temporary CPT codes identifiable by a trailing 'T' used for emerging technologies, services, and procedures intended for data collection.

Revision History

12/15/2024focused_review

Focused review — Revised policy statement.

4/15/2025focused_review

Focused review — No clinical policy statement changes.

2/15/2025focused_review

Focused review — No clinical policy statement changes.

Policy Summary

PayerCigna

PolicyMedical Coverage Policy

Policy CodePolicy 0558

Change TypeClarified; Revised

Effective DateApr 15, 2026

Next Review DateAug 15, 2026

SourceLink

On This Page

Ambulatory External and Implantable Electrocardiographic Monitoring — Category III CPT Code(s) = 0650T
Behavioral Health Coaching and Peer Support Services — Category III CPT Code(s) = 0591T, 0592T
Brexucabtagene autoleucel — Category III CPT Code(s) = 0537T, 0538T, 0539T, 0540T
Diabetes Equipment and Supplies — Category III CPT Code(s) = 0446T, 0447T, 0448T
Glaucoma Surgical Procedures — Category III CPT Code(s) = 0449T, 0671T
eviCore Pediatric Cardiac Imaging guideline — Category III CPT Code(s) = 0501T, 0502T, 0503T, 0504T
eviCore Adult Head Imaging guideline — Category III CPT Code(s) = 0042T
Idecabtagene vicleucel / CAR-T therapies: Idecabtagene vicleucel / Lisocabtagene maraleucel / Tisagenlecleucel / Yescarta (CAR-T) — Category III CPT Code(s) = 0537T, 0538T, 0539T, 0540T
Intensive Behavioral Interventions — Category III CPT Code(s) = 0362T, 0373T
Pancreatic Islet Cell Transplantation — Category III CPT Code(s) = 0584T, 0585T, 0586T
Preventive Care Services — Category III CPT Code(s) = 0403T, 0488T, 0500T
Scar Revision — Category III CPT Code(s) = 0479T, 0480T
Transcatheter Heart Valve Procedures — Category III CPT Code(s) = 0483T
Collective CAR-T reference: Brexucabtagene autoleucel / Idecabtagene vicleucel / Lisocabtagene maraleucel / Tisagenlecleucel / Yescarta referenced collectively — Category III CPT Code(s) = 0537T, 0538T, 0539T, 0540T

Related Coverage Resources list specific Cigna policies that may consider certain Category III codes medically necessary.
Those related policies may have their own prior authorization and utilization review rules.

Billing Rule

Deleted/ineffective codes

Deleted codes and codes not effective on the date the service is rendered may not be eligible for reimbursement. Ensure codes reported are active and effective for the date of service.

Deleted codes may not be eligible for reimbursement.
Codes not effective at the time the service is rendered may not be eligible for reimbursement.

4/15/2025focused_review

Focused review — No clinical policy statement changes.

8/15/2025annual_review

Annual review — No clinical policy statement changes.

10/15/2025focused_review

Focused review — No clinical policy statement changes.

4/15/2026focused_reviewLatest

Focused review — No clinical policy statement changes.

clarificationLatest

Related Coverage Resources list Category III codes that may be addressed by other Cigna policies; Category III codes are considered experimental/investigational/unproven unless a specific policy provides coverage.

Medical Coverage Policy

Coverage Summary

Medical-Necessity Criteria

Coding (Category III CPT Codes)

Provider Actions / Billing Guidance

Background

Exceptions and Related Coverage Policies

Revision History