The  new CPT code is:" 0278T Transcutaneous electrical modulation pain  reprocessing (e.g., scrambler therapy), each treatment session (includes  placement of electrodes)."

The AMA continues with the definition of the CPT III code:
However, the assignment of a CPT Category III code to a service does not  indicate that it is experimental or of limited utility, but only that  the service or technology is new and is being tracked for data  collection. In the Final Rule for the 2002 Medicare Physician Fee Schedule (Federal Register, Thursday, November 1, 2001), the Center  for Medicare and Medicaid Services (CMS) stated that they believed that  Category III codes will serve a useful purpose and that payment for the  service is at the discretion of the Carriers, but that the codes could  be paid after entered into the computer systems. Local payment  determination is reasonable for Category III CPT codes. It is not  reasonable to categorically deny payment for CPT Category III codes since they are effectively more specific, more functional versions of  unlisted codes which many payers cover with appropriate documentation.

The AMA  continues:
Once payment policies are established of a Category III  Code, the need for documentation will be minimized since Category III  Codes are associated with unique and specific descriptions of the  service or procedure. Since Category III codes are part of the CPT code  set, all health care payers must be able to accept Category III codes  into their systems to comply with the standards for transactions and  code sets under HIPAA.  


1105 Milwaukee Ave., Riverwoods, IL 60015 • (847) 520-7111

©2012 Spero Pain Relief Therapy of Illinois, PC