Saturday, July 2, 2022

AMA Releases Bonanza of New Category III Codes, Don't Miss the Digital Pathology Codes

 AMA has released new Category III CPT codes, which will be effective on January 1, 2023

Where to Find Codes, Prices

The home page for Cat III codes is here.   The new Cat III codes are posted in PDF at:

This posting consolidates February and May CPT meeting actions.  These includes 2 February meeting revisions and 11 new codes.  There are 35 May new codes.

Whether stemming from the February or May meetings, they publish now on July 1 and become effective on January 1, 2023.  

Category III codes almost never receive national pricing from Medicare, but almost always receive hospital outpatient payment levels ("APCs").  For the latter, look to the July draft and November final hospital outpatient rulemaking this year.   

Nowadays, MAC contractors usually consolidate listings of all their locally-priced Category III codes on their websites, for example, Noridian, here.

Some New Codes: Digitizing 

There area  lot of diverse new codes, so the best source is to actually read through them.   Unfortunately, Category III codes and PLA codes come in no order other than chronologic by time approved, so related codes are not grouped together.

For the lab industry, note that pages 7-8 are numerous codes for "digitization of glass microscope slides," issued one by one for the different levels of surgical pathology.   For example, 0753T is Level IV surgical pathology aka 88305.   The AMA states that digitization enables remote examination, and these are add-on codes (e.g. 88305+0573T).   There are also add-on codes for the staining codes for special stains, IHC, etc. 

AMA also states "do not report solely for archival purposes" or developing a database or education.  Note that if payable, the patient would be assigned a copay for these codes.  It will be interesting to see how CMS prices these in the Outpatient APC system and how MACs handle them when January 2023 arrives.