CPT Codes are Now Active
Physicians and suppliers are excited because as of July 1, 2019, the American Medical Association (AMA) is using provisional CPT® Codes corresponding to Surgical Planning, Guides, 3D Anatomical Models, and corresponding products and services.
CPT® stands for “Current Procedural Technology” and there are three distinct categories of evidence-based codes that insurance providers use to quantify medical procedures and services. Category I represents the standard procedures or services provided by a physician. Category II represents a product performance metric that can be optionally submitted with Category I codes.
The codes for Surgical Planning (Splints and Guides) and 3D Models fall under a provisional Category III, meaning they are for the AMA to qualify and observe new or emerging technologies. Trends identified in this Category III phase are used to better inform the 2020 CPT Code Publication.
What might this mean for me?
- Insurance Billing Options. All MedCAD products now have corresponding CPT codes from July 1 onward. Coverage may vary by insurance provider.
- Pricing with 2020 in Mind. Because these codes are provisional, it is important to price fairly to give insurance the most realistic expectation of what to cover. Until 2020 these cases will likely be individually quoted and billed, depending on the hospital contracts with suppliers. Charging too much will compromise the amount insurance is willing to cover, and charging too little may “burn” the market and make surgical planning and 3D models financially unsustainable for service providers.
- Refer to the CPT® Best-Practices and Guidances here.
What are the codes?
As these codes are provisional, they may change after the provisional period with the release of new codes in 2020. As they stand now, these are the relevant codes sourced from the AMA CPT® Category III Codes Publication:
| Code | Descriptor | Released to AMA Website | Effective Date | Publication |
|---|---|---|---|---|
| 0558T |
Computed tomography scan taken for the purpose of biomechanical computed tomography analysis (Do not report 0558T in conjunction with 71250, 71260, 71270, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 74263, 75571, 75572, 75573, 75574, 75635, 78816) |
January 1, 2019 | July 1, 2019 | CPT® 2020 |
| 0559T | Anatomic model 3D-printed from image data set(s); first individually prepared and processed component of an anatomic structure | January 1, 2019 | July 1, 2019 | CPT® 2020 |
| 0560T |
^ each additional individually prepared and processed component of an anatomic structure (List separately in addition to code for primary procedure) (Use 0560T in conjunction with 0559T) (Do not report 0559T, 0560T in conjunction with 76376, 76377) |
January 1, 2019 | July 1, 2019 | CPT® 2020 |
| 0561T | Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide | January 1, 2019 | July 1, 2019 | CPT® 2020 |
| 0562T | ^ each additional anatomic guide (List separately in addition to code for primary procedure) | January 1, 2019 | July 1, 2019 | CPT® 2020 |
In Summary
Physicians and suppliers are excited because these CPT® Codes are a major step forward in making valuable services like Surgical Planning and 3D Anatomical Models more accessible for the procedures that need them most. New to the CPT® 2020 Lineup:
- Surgical Planning (Splints, Guides, etc.)
- 3D Anatomical Models,
- The required CT’s for these products and services.