2024 Urology CPT Code Updates: What You Need to Know

 


The CPT code set for 2024 has recently been released. The modifications discussed below pertain specifically to urology and will become effective on January 1, 2024, across all payers. While pricing and coverage details will be finalized for certain procedure codes, primarily for Medicare, with the release of the Medicare Physician Fee Schedule in late October or early November, we will keep you updated on these determinations and their anticipated impact on urology.

A notable portion of the new codes falls under the category of CPT Category III codes. These will necessitate additional investigation, particularly in terms of coverage and payment rates, especially when dealing with private payers. It’s crucial to bear in mind that CPT Category III codes are officially recognized as CPT codes and should be used to report services rendered, provided they most accurately describe the services offered, unless explicit instructions have been given by a payer (we strongly advise obtaining this in written form).

Traditionally, Medicare does not assign work relative value units (wRVUs) to CPT Category III codes. Nevertheless, it is becoming increasingly common for Medicare to include Category III services in its coverage. Some Medicare Administrative Contractors (MACs) may even publish local coverage articles. Furthermore, the Centers for Medicare & Medicaid Services (CMS) may categorize Category III codes for payment purposes in ambulatory surgical centers and hospital outpatient department payment classifications. This ensures specific reimbursements to facilities, even in the absence of established payment rates for physician services or coverage for the particular service, drug, or supply.

https://www.allzonems.com/2024-urology-cpt-code-updates/

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