DecisionHealth, DecisionHealth - 2022 Issue 6 (June)

Provider response is mixed when category III codes become permanent

When the AMA replaced 10 temporary category III codes with 14 permanent category I codes in 2019, providers generally — but not always — boosted their reporting of the replacement codes. The category III codes, also known as T codes, were carrier-priced, which means that each Medicare administrative contractor (MAC) decides whether it will cover the service and how much it will pay on a case-by-case basis. Permanent codes are usually assigned an active payment status.

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