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, or unproven unless a specific Cigna Coverage Policy for a particular Category III code states otherwise. Related coverage resources list Category III codes that may be considered medically necessary in other policies.

Policy Summary

PayerCigna

PolicyMedical Coverage Policy

Policy CodePolicy 0558

Change TypeFocused/Annual reviews (one revised statement 12/15/2024)

Effective DateApr 15, 2026

Next Review DateAug 15, 2026

Key ActionWhen billing, providers must use the most appropriate codes as of the date of service and include covered diagnosis/procedure codes; services billed without covered codes under the applicable Coverage Policy will be denied as not covered.

SourceLink

POLICY UPDATE CHANGES

Focused reviews and annual reviews noted 'No clinical policy statement changes' for multiple review dates.

Revision entry dated 12/15/2024 indicates the policy statement was revised.

~100+Category III codes listed

SeveralRelated Coverage Policies

0Category III codes covered without separate policy

Coverage Summary

Payer: Cigna Companies; Policy title/number: Medical Coverage Policy — CPT Category III (T) Codes, Coverage Policy Number 0558. Effective date: 2026-04-15; Last review date: 2025-10-15; Next review date: 2026-08-15.

Scope summary: 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 for a particular Category III code states otherwise. Related coverage resources list Category III codes that may be considered medically necessary in other policies.

By default Category III codes are considered experimental/investigational/unproven unless a specific Cigna Coverage Policy states otherwise.

Key items — Category III (T) codes

Category III codes listed~100+

Related Coverage Policies referencing Category III codesSeveral

General Category III codes covered without separate policy0

Coverage stance

Medical-Necessity Criteria

General Coverage Policy

Coverage for CPT Category III codes:

Default stance: CPT 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.
Related policy precedence: When a specific Cigna Coverage Policy extends coverage to a particular Category III code, that policy's criteria apply.
Billing and coverage requirement: Claims will be denied as not covered when services are billed with codes not accompanied by covered diagnosis and/or procedure codes under the applicable Coverage Policy.

Coding

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

0207T	Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral.
0338T	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; 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).
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.

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Provider Actions

Documentation Required

Use appropriate codes and supporting documentation

When billing, providers must use the most appropriate codes as of the date of service and include the covered diagnosis and/or procedure codes required by the applicable Coverage Policy. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.

Prior Authorization

Prior authorization may be required per related policies

If a Category III code is addressed as covered in a separate Cigna Coverage Policy, providers must follow that policy's prior authorization and documentation requirements.

Background

Definitions and purpose: Category III (T) codes — temporary CPT codes (four digits followed by the letter 'T') used to identify emerging technologies, services, and procedures for data collection.

Purpose: Category III codes are assigned to procedures and services to collect data on clinical efficacy, utilization, and outcomes and to support regulatory processes (eg, FDA). They enable clinicians to report emerging services while evidence is being developed.

Typical evidence limitations: Services represented by Category III codes commonly lack published, peer‑reviewed evidence demonstrating clinical efficacy, safety, or standard‑of‑care applicability; many Category III codes are archived after approximately five years and may not ultimately receive a Category I CPT code.

Revision History

12/15/2024revision

Revised policy statement.

4/15/2025focused review

Focused review noted: No clinical policy statement changes.

10/15/2025focused review