Codes for quantification of coronary atherosclerosis are not suitable for hospital billing but may be payable under the physician fee schedule

Q.

Do you have any information regarding CPT^® Category III codes 0623T-0626T?    Are these appropriate for facility billing?  And if so, when would be these be billed?

A.

These codes for quantification of coronary atherosclerosis are not suitable for hospital billing. Under OPPS, the status indicator is E1 

E1 Items, Codes, and Services: Not paid by Medicare when submitted on outpatient claims (any outpatient bill type).

●  Not covered by any Medicare outpatient benefit category

●  Statutorily excluded by Medicare    

●  Not reasonable and necessary 

They may be payable under the Medicare Physician Fee Schedule. They have a status of “C” meaning that each Medicare contractor will determine coverage and payment for their jurisdictions.. 0623T is a global charge.  If not charging the global charge, the 0624T and 0625T are technical components and 0626T is the professional component. 

The full codes and their descriptions are:

0623T Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission, computerized analysis of data, with review of computerized analysis output to reconcile discordant data, interpretation and report

0624T Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission

0625T Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; computerized analysis of data from coronary computed tomographic angiography

0626T Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; review of computerized analysis output to reconcile discordant data, interpretation and report

The AMA book “CPT Changes 2021 – An Insider’s View” has a good description for these codes (as well as all new CPT codes.)