Additional Information Required for Coverage and Pricing for Category III CPT Codes - R6

The Local Coverage Article (LCA) Additional Information Required for Coverage and Pricing for Category III CPT® Codes has been created and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI) and 01312 (NV).

Summary of Changes: This article revised for the new, deleted and description changes of CPT codes.

  • New CPT codes added to Group 1
    • 0510T, 0511T, 0512T, 0513T, 0514T, 0515T, 0516T, 0517T, 0518T, 0519T, 0520T, 0521T, 0522T, 0523T, 0524T, 0525T, 0526T, 0527T, 0528T, 0529T, 0530T, 0531T, 0532T, 0533T, 0534T, 0535T, 0536T, 0540T, 0541T, 0542T
  • New CPT codes added to Group 4
    • 0509T, 0537T, 0538T, 0539T
  • Deleted CPT codes from Group 1
    • 0159T, 0190T, 0195T, 0196T, 0337T, 0359T, 0360T, 0361T, 0363T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, 0370T, 0371T, 0372T, 0374T
  • Deleted CPT codes from Group 2
    • 0346T, 0406T, 0407T
  • Deleted CPT codes from Group 3
    • 0188T, 0189T
  • Deleted CPT codes from Group 4
    • 0387T, 0388T, 0389T, 0390T, 0391T
  • Description changed for the following codes
    • 0335T - Insertion of sinus tarsi implant
    • 0362T - Behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior
    • 0373T - Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior

Effective Date: January 1, 2019

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Last Updated Jan 11, 2019