CurrentCignaPolicy N/A

CPT Category III (Category III/T) Codes

Defines Cigna's coverage stance for CPT Category III (temporary 'T') codes for emerging technologies and procedures; applies to providers submitting claims to Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyCPT Category III (Category III/T) Codes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse the most appropriate codes as of the submission effective date and note that prior authorization requirements are determined by the applicable benefit plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multipleCategory III codes listed as considered experimental/investigational/unproven

1Related Medicare LCD referenced for Category III Codes (L35490)

0Policy statements that extend blanket coverage to Category III codes (general policy stance)

8Pages in the document

Coverage Criteria

Default stance

Covered only if addressed by a specific Cigna Coverage Policy that extends coverage.

General rule: Category III codes are considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy separately addresses and extends coverage to a particular Category III code.

These temporary 'T' codes are intended primarily for data collection and are not by themselves evidence of clinical efficacy or standard of care.

Cigna's general policy position is that Category III CPT ("T") codes are considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy separately addresses and extends coverage to that particular Category III code. Category III codes are temporary codes intended primarily for data collection and evaluation; therefore blanket coverage is not provided in this policy absent a separate coverage policy that explicitly permits payment.

The following Category III CPT codes are considered experimental, investigational, or unproven and are not medically necessary under this policy unless a separate Cigna Coverage Policy expressly provides coverage: 0207T, 0339T, 0342T, 0351T, 0439T, 0442T, 0489T, 0525T, 0546T, 0559T, 0560T, 0561T, 0582T, 0587T, 0590T, 0600T, 0601T, 0608T, 0620T, 0643T, 0644T, 0646T, 0647T, 0659T, 0686T, 0689T, 0724T, 0742T, 0794T, 0805T, 0806T, 0807T, 0808T, 0882T, 0888T, 0947T, 0956T, 0957T, 0959T, 0960T, 0967T, 0968T, 0970T, 0977T, 0978T, 0979T, 0980T.

Coding — Category III (T) Codes

Considered Experimental/Investigational/UnprovenCPTNot Covered

0207T	Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral.
0339T	Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; 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, for assessment of myocardial ischemia or viability (List separately in addition to code for primary procedure).
0442T	Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve).
0489T	Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; adipose tissue harvesting, isolation and preparation of harvested cells including incubation with cell dissociation enzymes, removal of non-viable cells and debris, determination of concentration and dilution of regenerative cells.
0525T	Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; complete system (electrode and implantable monitor).
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 of an anatomic structure.

1–10 of 47

1/5

Category III codes addressed in other Cigna policies (may be covered per those specific policies)CPT

0650T	Ambulatory External and Implantable Electrocardiographic Monitoring (listed under related coverage policies).
0591T	Behavioral Health Coaching and Peer Support Services (related policy).
0592T	Behavioral Health Coaching and Peer Support Services (related policy).
0537T	Brexucabtagene autoleucel / CAR-T related codes (listed under related coverage policies).
0538T	Brexucabtagene autoleucel / CAR-T related code.
0539T	Brexucabtagene autoleucel / CAR-T related code.
0540T	Brexucabtagene autoleucel / CAR-T related code.
0446T	Diabetes Equipment and Supplies (related policy).
0447T	Diabetes Equipment and Supplies (related policy).
0448T	Diabetes Equipment and Supplies (related policy).

1–10 of 28

1/3

Policy currency vs AMA/CMS updates

Scope of listThis policy's code list may not be all-inclusive; AMA and CMS code updates can occur more frequently than policy updates.

Deleted or inactive codesDeleted codes and codes not effective on the date the service is rendered may not be eligible for reimbursement.

Responsibility for currencyProviders should confirm current code status with AMA/CMS resources because policy updates may lag external code changes.

Category III CPT (T) codes definition

DefinitionCategory III CPT codes are temporary codes identified by a trailing 'T' (four digits followed by the letter T) assigned to emerging technologies, services, and procedures.

Primary purposeIntended primarily for data collection to substantiate clinical efficacy, utilization, and outcomes, and to support FDA processes.

Duration and fateCategory III codes are generally archived after five years and may or may not receive a Category I CPT code; if not, reporting may require a Category I unlisted code.

Interpretation cautionUse of a T code does not indicate endorsement of clinical efficacy, safety, or standard-of-care status by the AMA.

Provider Actions and Billing

Prior Authorization

Plan-determined prior authorization

Prior authorization requirements are determined by the member's applicable benefit plan document. Providers should verify whether prior authorization is required for the requested service with the member's plan before rendering care.

Note

Provider-impact note

Check the applicable Coverage Policy and the member's benefit plan for any short, provider-impact notes that may affect ordering or documentation requirements for this service.

Billing Rule

Coding and billing requirement

When submitting claims, providers must use the most appropriate diagnosis and procedure codes in effect on the date the claim is submitted. Reimbursement will not be allowed for services billed with codes that are not covered under the applicable Coverage Policy.

Use current CPT/HCPCS/ICD-10 codes as of the claim submission date.
Ensure billed codes align with the Coverage Policy's listed covered codes.

Denial Risk

Denial for non-covered codes

Claims for services submitted without covered code(s) under the applicable Coverage Policy will be denied as not covered. Review the member's plan document and the Coverage Policy to confirm covered codes before billing.

Denied when billed with non-covered codes.
Confirm coverage and obtain any required authorizations prior to service.

Prior Authorization

Prior authorization determination by benefit plan

Prior authorization requirements are determined by the terms of the applicable benefit plan and are not specified in this policy; providers must consult the member's benefit plan to determine authorization needs.

Not Covered

Not covered: Category III CPT codes listed in this policy are not covered when they are not specifically addressed by another Cigna Coverage Policy. See the 'Considered Experimental/Investigational/Unproven' code list for the specific Category III codes that are treated as not covered under this policy.

Background

Background: Category III CPT codes are temporary codes for emerging technologies, services, and procedures intended primarily for data collection. They are used to support evaluation and potential future Category I coding, and there is frequently limited peer‑reviewed evidence for clinical efficacy and safety for services represented by Category III codes.

Definitions

Definition of Category III CPT (T) codes

What they areTemporary CPT codes with a trailing 'T' used to identify emerging technologies, services, and procedures for data collection and evaluation.

Identification formatFour numeric digits followed by the letter T (e.g., 0123T).

Purpose of assignmentAssigned to collect clinical and utilization data to support potential future Category I coding and regulatory submissions.

Not evidence of endorsementA T code does not imply clinical efficacy, safety, or applicability are established; peer-reviewed evidence is typically limited.