Current procedural terminology (CPT) includes both the typical 5-digit Category I codes but also a 5-character (4 digits and the letter T) Category III code. Unlike Category I codes, Category III codes are temporary codes that are used to report new and emerging technologies, services, and procedures. The American Medical Association CPT website publishes updates of the Category III sets in July and January of each calendar year according to the Category III Code Semi-Annual Early Release Schedule. Although publication of Category III codes through early release to the CPT website allows for expedient dispersal of the code and descriptor, early availability does not imply that these codes are immediately reportable before the indicated implementation date. It is important to be aware of new Category III codes to ensure appropriate use and reporting. New Category III codes of interest to urology for July 1, 2024 include the following.

New Category III CPT Code for Transperineal Laser Ablation of Benign Prostatic Hyperplasia

0714T Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance; prostate volume less than 50 mL

0867T ….prostate volume greater or equal to 50 mL

(Do not report 0714T, 0867T in conjunction with 76940, 76942, 77002, 77012, 77021)

There are 2 new Category III codes that can be used to report the performance of transperineal laser ablation of the prostate, a minimally invasive procedure for the treatment of benign prostatic hyperplasia (BPH). This procedure involves using a laser through a transperineal route to ablate (destroy) excess benign prostate tissue in men with prostatic obstruction from BPH. According to a systematic review published in Therapeutic Advances in Urology,¹ transperineal laser ablation appears to be effective for BPH as an alternative to other surgical techniques, such as transurethral resection of the prostate or open surgery. Note that there are 2 codes (not in numerical sequence) that are used based upon prostate size (less than or greater than 50 mL), and the parenthetical instructs one not to report these codes with imaging modalities of the prostate performed concomitantly, as imaging is part of the procedure.

New Category III CPT Code for Renal Histotripsy

0888T Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance

Histotripsy is a noninvasive, nonthermal focused ultrasound tissue ablative technology that can be used as an alternative to surgical or other ablative procedures to treat tissues, for example tumors in the liver or kidney, among other uses. Histotripsy uses pulsed sound waves that travel through the body focused on the target tissue, where the sound waves then induce bubble clouds from gases naturally present in the targeted tissue. These bubble clouds form and collapse in microseconds, creating mechanical forces strong enough to destroy tissue at cellular and subcellular levels, leading to cavitation and rendering the target into an acellular debris, which is absorbed by the body within a few months.²

New Category III CPT Code for Prostate Cancer Estimation

0898T Noninvasive prostate cancer estimation map, derived from augmentative analysis of image-guided fusion biopsy and pathology, including visualization of margin volume and location, with margin determination and physician interpretation and report

(Do not report 0898T in conjunction with 76376, 736377)

CPT 0898T can be used to report the work of performing a noninvasive prostate cancer estimation map. A current example is Unfold-AI, an artificial intelligence–based mapping tool for prostate cancer by Avenda Health (avendahealth.com). Data on the use of this tool were published in European Urology Open Science,³ showing superior efficacy of Unfold AI in determining cancer risk over the current standard of care. Specifically, the AI-based tool, which incorporates biomarker, biopsy, and image features, demonstrated an 80% rate of complete encapsulation of clinically significant prostate cancer, compared with 56% with conventional margins. Further, in almost half of cases assessed, Unfold AI uncovered clinically significant disease beyond that with conventional margin boundaries.

CPT Category III codes are a set of temporary codes that allow data collection for emerging technologies, services, and procedures. These codes are intended to be used for data collection to substantiate widespread usage or to provide documentation for the FDA approval process. Category III codes allow data collection for these services or procedures, unlike the use of unlisted codes which do not offer the opportunity for the collection of specific data. If a Category III code is available, this code must be reported instead of a Category I unlisted code. It is important to remember that having a CPT code does not represent endorsement by the AMA of any particular diagnostic or therapeutic procedure or service. In addition, Category III codes are not referred to the AMA-Specialty RVS Update Committee for valuation because no relative value units are assigned to these codes. Payments for these services or procedures are based on the policies of payers and not on a yearly fee schedule.