1.0 DESCRIPTION
Category III codes are a set
of temporary codes for emerging technology, services, and procedures.
These codes are used to track new and emerging technology to determine
applicability to clinical practice. When a Category III code receives
a Category I code from the American Medical Association (AMA) it
does not automatically become a benefit under TRICARE. However,
the codes that may have moved from unproven to proven must be forwarded
to the Office of Medical Benefits and Reimbursement Section (MB&RS)
for coverage determination/policy clarification.
2.0 POLICY
2.1 Category III codes are to be
used instead of unlisted codes to allow the collection of specific
data. TRICARE has not opted to track Category III codes at this
time.
2.2 Category
III codes are excluded from coverage, unless specifically noted
in policy, since clinical safety and efficacy or applicability to
clinical practice has not been established.