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New Cat. III Spine Codes for July 1

The following three spine Category III Codes released by the AMA on January 1, 2009 become effective July 1, 2009. The use of an unlisted procedure code will no longer be the correct CPT code on July 1, 2009. The three new Category III Codes will be included in the 2010 CPT Manual as new codes.

Note: Category III Codes 0200T and 0201T have a “bulls-eye” symbol indicating that Conscious Sedation is an inclusive component of these procedures and may not be reported separately. Category III code 0202T does not include this designation thus Conscious Sedation is separately reportable if administered by a physician in the absence of an anesthesiologist/CRNA.

Medicare announced in the July 2009 Update to the Ambulatory Surgical Center (ASC) Payment System; Summary of Payment Policy Changes that 0200T and 0201T are separately reimbursable in an ASC setting.

Action Steps

  • Add these three new Category III Codes to your practice management system.

  • Set a fee for these procedures using the fee setting methodology for unlisted procedures.

  • Update Charge Capture Tools to include these three new codes as applicable in our practice.

  • Begin using these codes July 1, 2009.

  • Obtain written prior authorization for this procedure to determine payor payment policies and potential patient responsibility if the payor denies for medical necessity.

  • Obtain waivers or an ABN per payor specific rules.

CPT Codes and Descriptors Table

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