Updated Service Request
April 16, 2019

CPT Codes for Surgical Planning, Guides, and 3D Models

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?

  1. Insurance Billing Options. All MedCAD products now have corresponding CPT codes from July 1 onward. Coverage may vary by insurance provider.
  2. 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.
  3. 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: 

 

 

This website and the material contained herein are intended for informational purposes only. Nothing herein is advice, legal advice or a recommendation of any kind, and it should not be considered as such. The content of this website was obtained from the third party sources cited within and is subject to change without notice, resulting from changes in reimbursement laws, regulations, rules and policies. Copying or distributing any content from this website is strictly prohibited. All content is informational only, general in nature, and does not cover all situations or all payers’ rules or policies. The content is not intended to apply to any particular situation. In all cases, the service and the product must be reasonable and necessary for the care of the patient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patients’ medical condition, procedures performed and the products used. The information on this website represents no promise or guarantee by MedCAD regarding coverage or payment for products or procedures by Medicare or other payers. This website may not be used as an official source of information. Providers should check Medicare bulletins, manuals, program memoranda, Medicare guidelines and other payer information to ensure compliance with Medicare and other payer requirements. Inquiries can be directed to the hospital’s Medicare Part A fiscal intermediary, the physician’s Medicare Part B carrier, or to appropriate payers. MedCAD specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this website.