Billing and Coding: Category III Codes

This Billing and Coding Article defers coverage, coding, and medical necessity determinations for Category III codes to the referenced LCDs and their Billing and Coding Articles; services are covered only when the corresponding LCD/article criteria are met and the performing physician meets provider qualifications. Specific CPT/HCPCS codes are redirected or deleted (e.g., 0295T–0298T deleted; 0501T–0504T moved to LCD L38839), and certain procedures (implantable glucose sensors, transurethral waterjet ablation, ECG monitoring) must follow their respective LCDs for coverage and documentation. Documentation must be legible, include patient identification, dates of service, practitioner signature, and must support the ICD-10 and CPT/HCPCS codes billed.

"Billing and coding for Category III codes is allowed only when the service meets the coverage indications, limitations, and medical necessity criteria described in LCD L35490 and the performing phy..."