Pathways' Pick of the Week: CPT Code Updates

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ARTICLE SUMMARY:

Highlights from the September CPT Editorial Panel meeting. Excerpted from Pathways Picks October 25: EU Structured Dialogue, FDA Off-Label Guide, and More.

The American Medical Association’s CPT panel has agreed to convert the existing Category III code for MRI-guided high-intensity focused ultrasound (MRgFUS) to a Category I code, which is more routinely accepted by payors, based on a September meeting summary posted October 24. The upgrade, which will take effect in January 2025, is a step forward in Insightec’s reimbursement strategy recently profiled in Market Pathways. (See “Insightec: The Rocky Road Taking a New Technology From Cash Pay to Reimbursement,”Market Pathways, September 28, 2023.)

Overall, the panel accepted 32 Category I codes (including add-ons) last month. It also awarded 34 Category III codes for newer technologies and services including codes for AI-generated prostate cancer mapping and endoscopic drug-coated GI balloons, and it revised seven additional codes.  Four revisions targeted Category I codes (98975-98978) describing remote therapeutic monitoring in support of digital cognitive behavioral therapy (CBT). The panel agreed to revise the codes and associated guidances to explicitly incorporate “digital therapeutic intervention” as part of the service.

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