See my September 4, 2025 blog, where CMS releases Part B utilization for CY2024 by CPT code. I discussed utilization of lab codes there.
Category III Codes
Let's revisit the 2024 data and ask about Category III codes. Category III codes are now breaking 900 in terms of total codes issued. While many have been "sunsetted" some Category III codes as early as 0042U are still in use.
For 2024, CMS lists about 370 Category III codes in the utilization data, but about 100 of those have utilization of $0 and another 100 or so are below $1000. So, only 170 of 370 codes had utilization over the low bar of $1000.
Total payments in 2024 for Cat III were about $225M.
Generally, prices are set locally, so they may differ MAC to MAC. Of the top 7 codes, 1 paid over $5000, while 3 paid in the $2100-2700 range.
Utilization of Top Category III Codes
Let's look at utilization from the top down.
Category III code utilization is extremely skewed, with two-thirds of the money (66%) going to just the top 5 of 370 codes. The top 7 codes get 75% of the money ($166M). The top 25 codes are 95% of the money, leaving just 5% of the money for the other ~350 codes.
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Most of the top codes are surgical, either eye surgery or back surgery.
- Code 0275T for lumbar laminectomy had a mean fee of $2723, 26,108 services, paying $71,087,000.
- Code 0627T for cellular product injection, disk, had a mean fee of $5,263, 8,469 services, and paying $44,574,000.
- 0394T for skin brachytherapy (radiation) had a mean fee of $186, 69,000 services, and paying $12,864,000.
