CurrentCignaPolicy 0558

Medical Coverage Policy

Defines Cigna's coverage position for CPT Category III (T) codes: by default these temporary/emerging technology codes are considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy addresses and provides coverage criteria for a particular Category III code.

Policy Summary

PayerCigna

PolicyMedical Coverage Policy

Policy CodePolicy 0558

Change TypeClarified/Revised (no material clinical changes)

Effective DateApr 15, 2026

Next Review DateAug 15, 2026

Key ActionSubmit services with covered diagnosis and/or procedure code(s) that align with the applicable Coverage Policy; claims lacking covered codes under the applicable Coverage Policy will be denied as not covered.

SourceLink

POLICY UPDATE CHANGES

Policy reiterates that Category III codes are considered experimental/investigational unless specifically covered by another Cigna policy.

Focused review entries note prior reviews with 'No clinical policy statement changes.'

~100+Category III codes listed in policy

MultipleRelated Coverage Resources linking specific T codes to separate policies

0Category III codes covered by this policy absent separate policy criteria

Coverage Summary & Position

Defines Cigna's coverage position for CPT Category III (T) codes: by default these temporary/emerging technology codes are considered experimental, investigational, or unproven unless a specific Cigna Coverage Policy addresses and provides coverage criteria for a particular Category III code. Effective date: 4/15/2026. See Related Coverage Resources for Category III codes that are governed by separate Cigna policies.

General Coverage Position

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

CPT Category III codes are temporary codes for emerging technologies, services, and procedures used primarily for data collection.
Items, services, or procedures represented by Category III codes are considered experimental, investigational, or unproven, unless coverage for that specific Category III code is separately addressed in a Cigna Coverage Policy.
If a Cigna Coverage Policy specifically extends coverage to a particular Category III code (see Related Coverage Resources), that separate policy governs coverage and criteria for that code.

CPT Category III Codes

Considered Experimental/Investigational/Unproven (Category III Codes listed)CPTNot Covered

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, for assessment of myocardial ischemia or viability.
0489T	Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; harvesting 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, with report.
0559T	Anatomic model 3D-printed from image data set(s); first individually prepared and processed component.

1–10 of 56

1/6

What Providers Must Do

Documentation Required

Use Covered Diagnosis/Procedure Codes

Submit services with covered diagnosis and/or procedure code(s) that align with the applicable Coverage Policy; claims lacking covered codes under the applicable Coverage Policy will be denied as not covered.

Prior Authorization

Refer to Specific Coverage Policies for Prior Authorization

If a Category III code is addressed and permitted by a specific Cigna Coverage Policy, follow that policy's prior authorization and documentation requirements.

Actionable guidance: services billed with Category III codes that are not supported by a covered diagnosis/procedure under the applicable Coverage Policy will be denied as not covered. Submit services with covered diagnosis and/or procedure codes that align with the applicable Coverage Policy; follow any specific prior authorization/documentation requirements in the separate Cigna policy when a Category III code is addressed there.

Background & Definitions

Background: CPT Category III codes are temporary four-digit codes with a trailing 'T' assigned to emerging technologies, services, and procedures and intended primarily for data collection to substantiate broader use or support regulatory processes. They are generally archived after five years and may or may not become Category I CPT codes; if no Category I cross-reference exists when archived, the service is reported with a Category I unlisted code. Typically there is limited peer-reviewed evidence supporting clinical efficacy, safety, or applicability, and these services are not considered an established standard of care.

Definition: Category III CPT Codes (T codes) — temporary four-digit CPT codes with a trailing 'T' used to identify emerging technologies, services, and procedures for data collection.

Policy Revision History

4/15/2025revised

Focused Review, Summary of Changes = Revised policy statement.

2/15/2025revised

Focused Review, Summary of Changes = No clinical policy statement changes.

12/15/2024revised