Billing and Coding: Category III Codes

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated LCD L35490 Category III Codes with the exception of the following
CPT codes:

  * 2021 CPT/HCPCS Annual code update: 0295T, 0296T, 0297T, and 0298T deleted. Effective 01/01/2021. Please refer to LCD L34636 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) and A57476 Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring). The physician (MD/DO) performing the service must meet all criteria in this LCD and Billing and Coding Article.

  * CPT Codes **0446T-** Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training, **0447T-** Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision, and **0448T-** Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation. Please refer to L38686 Implantable Continuous Glucose Monitors (I-CGM) and A58213 Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM). The physician (MD/DO) performing the service must meet all criteria in this LCD and Billing and Coding Article. Effective 10/11/2020.
  * CPT Code **0421T** - Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed) AND HCPCS Code **C2596** - Probe, image guided, robotic, waterjet ablation. Please refer to L38682 Transurethral Waterjet Ablation of the Prostate and A58209 Billing and Coding: Transurethral Waterjet Ablation of the Prostate. The provider performing this service must meet all criteria in that LCD and Billing and Coding Article. Effective 12/27/2020.

  * CPT Codes **0501T-0504T:** coverage in L35490 no longer applicable. Please refer to L38839 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease and A58473 Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease for Coverage Indications, Limitations, and/or Medical Necessity. Effective 04/25/2021.

**Frequency Limitation**

Medicare may cover only **1 unit per eye, per date of service of CPT code
0449T** for insertion of glaucoma drainage device(s) into the subconjunctival
space (e.g., XEN45), when the medically reasonable and necessary criteria as
stated in the LCD are met.

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and must support the medical necessity of the services as directed in this article and be made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.