CurrentCignaPolicy 0558

CPT Category III (T) Codes coverage policy

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

Policy Summary

PayerCigna

PolicyCPT Category III (T) Codes coverage policy

Policy CodePolicy 0558

Change TypeClarified (focused/annual reviews)

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; claims for services not accompanied by covered codes under the applicable Coverage Policy will be denied as not covered.

SourceLink

POLICY UPDATE CHANGES

Focused reviews and annual reviews between 8/15/2024 and 10/15/2025 documented; most recent revisions noted 'No clinical policy statement changes.'

~90+Category III codes listed

>=1Related policies that may cover specific T codes

1Primary coverage position

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Scope: Defines Cigna's coverage stance for CPT Category III (temporary 'T') codes: by default Category III codes are considered experimental/investigational/unproven unless a specific Cigna Coverage Policy explicitly addresses and extends coverage for a particular Category III code. The policy lists numerous Category III codes considered experimental/investigational/unproven and references related Coverage Policies that may consider certain Category III codes medically necessary for specified indications.

Policy-level summary: CPT Category III codes are temporary (T) codes intended for data collection for emerging technologies, services, and procedures; because of that purpose, items/services represented by Category III codes are considered experimental, investigational, or unproven unless a Cigna Coverage Policy specifically extends coverage to a particular Category III code. If a specific Cigna Coverage Policy does extend coverage to a Category III code, that policy's criteria apply.

Dates: Effective 4/15/2026; Last review 10/15/2025; Next review 8/15/2026.

Category III CPT codes — policy snapshot

Effective date2026-04-15

Last review2025-10-15

Next review2026-08-15

Primary coverage positionUnless a specific Cigna Coverage Policy addresses a Category III code, items/services represented by Category III codes are considered experimental, investigational, or unproven (coverage may be provided only if a specific Cigna Coverage Policy explicitly extends coverage).

Defined term — Category III CPT codesTemporary 'T' codes (four digits followed by 'T') for emerging technologies, services, and procedures intended for data collection; generally archived after five years and may transition to Category I codes.

Medical Necessity / Policy Rules

General coverage rule for Category III CPT codes

Unless a specific Cigna Coverage Policy addresses a Category III code, coverage determination follows:

ALL of the following

CPT Category III codes are intended for data collection for emerging technologies, services, and procedures and are temporary.
Items/services 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.
If a specific Cigna Coverage Policy extends coverage to a particular Category III code, that policy's criteria apply.
Claims submitted with services not accompanied by covered diagnosis and/or procedure codes under the applicable Coverage Policy will be denied as not covered.

Considered Experimental/Investigational/Unproven - examples

Exception — Related Coverage Policies that may consider specific Category III codes medically necessary

Coverage may be provided for certain Category III codes if they are addressed in other listed Cigna Coverage Policies:

ONE of

Ambulatory External and Implantable Electrocardiographic Monitoring considers Category III CPT code 0650T.
Behavioral Health Coaching and Peer Support Services consider Category III CPT codes 0591T, 0592T.
Brexucabtagene autoleucel / CAR-T related: Brexucabtagene autoleucel and related CAR-T policies consider Category III CPT codes 0537T, 0538T, 0539T, 0540T.
Diabetes Equipment and Supplies considers Category III CPT codes 0446T, 0447T, 0448T.

CPT Category III Codes — Status Groups

Category III CPT codes explicitly listed as Considered Experimental/Investigational/UnprovenCPTExperimental

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/prep.
0525T	Insertion or replacement of intracardiac ischemia monitoring system; complete system.
0546T	Radiofrequency spectroscopy, real time, intraoperative margin assessment at partial mastectomy.
0559T	Anatomic model 3D-printed from image data set(s); first component.

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Category III CPT codes referenced as potentially covered in related policiesCPT

0650T	Ambulatory External and Implantable Electrocardiographic Monitoring (referenced as considered in related policy).
0591T	Behavioral Health Coaching and Peer Support Services (referenced).
0592T	Behavioral Health Coaching and Peer Support Services (referenced).
0537T	CAR-T / related cellular therapy codes referenced across multiple related policies.
0538T	CAR-T related.
0539T	CAR-T related.
0540T	CAR-T related.
0446T	Diabetes Equipment and Supplies (referenced).
0447T	Diabetes Equipment and Supplies (referenced).
0448T	Diabetes Equipment and Supplies (referenced).

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Provider Actions & Billing Guidance

Documentation Required

Submit claims with covered diagnosis/procedure codes

When billing, providers must use the most appropriate codes as of the date of service; claims for services not accompanied by covered diagnosis and/or procedure codes under the applicable Coverage Policy will be denied as not covered.

Prior Authorization

Check related Cigna Coverage Policies for exceptions

Providers must determine if a specific Category III code is addressed by a separate Cigna Coverage Policy that extends coverage; if so, follow that policy's prior authorization and medical necessity criteria.

Related policies: Ambulatory External and Implantable Electrocardiographic Monitoring (0650T); Behavioral Health Coaching and Peer Support Services (0591T, 0592T); Brexucabtagene autoleucel / CAR-T related (0537T, 0538T, 0539T, 0540T); Diabetes Equipment and Supplies (0446T, 0447T, 0448T); Glaucoma Surgical Procedures (0449T, 0671T); eviCore Pediatric Cardiac Imaging guideline (0501T, 0502T, 0503T, 0504T); Intensive Behavioral Interventions (0362T, 0373T); Pancreatic Islet Cell Transplantation (0584T, 0585T, 0586T); Preventive Care Services (0403T, 0488T, 0500T); Scar Revision (0479T, 0480T); Transcatheter Heart Valve Procedures (0483T)

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

Background

Background: CPT Category III codes are temporary (T) codes for emerging technologies, services, and procedures intended for data collection to support clinical efficacy, utilization, outcomes, or regulatory documentation. These codes are identified as four digits followed by the letter T, are generally archived after five years, and may transition to a Category I CPT code or be reported with an unlisted Category I code if no cross-referenced Category I code is established. The AMA notes that a T code does not by itself indicate support for clinical efficacy or safety and typically there is limited peer-reviewed evidence supporting these services.

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

Revision History

2024-12-15revision

Focused Review — Revised policy statement.

2024-08-15annual_review

Annual Review — No clinical policy statement changes.

2025-02-15focused_review

Focused Review — No clinical policy statement changes.

2025-04-15focused_review

Focused Review — No clinical policy statement changes.

2025-04-15focused_review

Focused Review — No clinical policy statement changes.

2025-08-15annual_review

Annual Review — No clinical policy statement changes.

2025-10-15focused_review

Focused Review — No clinical policy statement changes.

2026-04-15effective_dateLatest

Current policy effective date.

Policy Summary

PayerCigna

PolicyCPT Category III (T) Codes coverage policy

Policy CodePolicy 0558

Change TypeClarified (focused/annual reviews)

Effective DateApr 15, 2026

Next Review DateAug 15, 2026

SourceLink

On This Page

OpenPayer

CPT Category III (T) Codes coverage policy

Coverage Summary

Medical Necessity / Policy Rules

CPT Category III Codes — Status Groups

Provider Actions & Billing Guidance

Background

Revision History