CPT® Innovation Watch: AMA Introduces 28 New Category III Codes for Emerging Medical Technologies

Understanding What the Latest Category III Updates Mean for Providers, Coders, and Revenue Cycle Leaders

The American Medical Association (AMA) continues to advance medical innovation and data-driven care delivery through its biannual updates to the CPT® code set. In its December 30, 2025 update, the AMA introduced 28 new Category III CPT® codes and revised four existing codes, signaling continued growth in emerging clinical technologies, digital healthcare solutions, and experimental therapeutic approaches.

While these changes primarily support tracking and data collection rather than immediate reimbursement, they play a critical role in shaping future coverage policies, payer decisions, and clinical adoption trends. For healthcare organizations, staying informed about these updates is essential to maintain compliance, support innovation, and ensure accurate reporting.

The new codes become effective July 1, 2026, following acceptance by the CPT® Editorial Panel at its September 2025 meeting for the 2027 CPT® production cycle.

What Are Category III CPT® Codes and Why They Matter

Category III CPT® codes are temporary codes created to track emerging technologies, services, and procedures. Unlike Category I codes, they do not require widespread clinical adoption or established efficacy before implementation.

Instead, these codes:

• Enable data collection on new technologies
• Help demonstrate clinical effectiveness and utilization trends
• Support regulatory review and FDA approval processes
• Lay the groundwork for future reimbursement pathways
• Provide visibility into evolving care delivery models

For providers and revenue cycle teams, reporting these services accurately helps shape future payment policies while documenting cutting-edge patient care.

Effective July 1, 2026: New Category III Codes at a Glance

The newly introduced codes span multiple specialties, including digital health, imaging innovation, cardiology, pulmonology, oncology, and regenerative medicine. A significant portion focuses on patient-specific modeling, monitoring technologies, and minimally invasive therapies.

Digital 3D Modeling and Personalized Anatomy: A Major Focus Area

One of the most notable updates includes 11 new codes related to surface mesh representations and digital three-dimensional modeling, highlighting the healthcare industry’s shift toward precision medicine and individualized treatment planning.

These technologies transform volumetric medical imaging data from traditional Digital Imaging and Communications in Medicine (DICOM) formats into surface mesh files. The resulting models can be digitally analyzed or physically produced using 3D printing to assist in surgical planning, procedural simulation, and patient-specific treatment.

3D-Printed Anatomical Models and Surgical Guides (0559T–0562T)

These codes describe the creation of customized 3D-printed structures derived from patient imaging:

• 0559T and +0560T — Production of individualized anatomical models using processed imaging data.
• 0561T and +0562T — Creation of patient-specific cutting or drilling guides to assist surgical procedures.

These services are increasingly used in orthopedics, cardiothoracic surgery, and complex reconstructive procedures to improve accuracy and outcomes.

Final Anatomic Representations (FARs) — Digital 3D Models (1030T–1035T)

These time-based codes capture the creation of Final Anatomic Representations (FARs) — highly detailed digital models derived from surface mesh files representing patient-specific anatomy.

Such models support:

• Preoperative planning
• Surgical simulation
• Medical education
• Treatment optimization
• Risk reduction in complex procedures

Their inclusion in CPT reflects the growing clinical reliance on digital modeling technologies.

New Technology-Driven Diagnostic and Therapeutic Services

Beyond 3D modeling, the update introduces several codes addressing advanced diagnostics and novel therapies.

Point-of-Care and Imaging Innovation

• 1043T — Quantitative magnetic resonance testing without imaging for liver assessment at the point of care.
• 1039T — Connectomic analysis of previously performed multimodal brain MRI, reflecting growing interest in neural connectivity mapping.
• 1036T — Noninvasive hemodynamic assessment for evaluating cardiovascular function.

These technologies emphasize faster diagnostics, enhanced disease characterization, and reduced procedural invasiveness.

Minimally Invasive and Regenerative Treatments

Several new codes reflect advances in therapeutic interventions:

• 1037T — Histotripsy for malignant pancreatic tissue using focused ultrasound technology.
• 1038T — Autologous muscle cell therapy, supporting regenerative medicine approaches.
• 1040T — Flexible bronchoscopy with bronchial cryotherapy.
• 1026T — Transvaginal laser photobiomodulation therapy for pelvic conditions.

These procedures demonstrate continued expansion in targeted, minimally invasive treatment modalities.

Advancements in Respiratory, Cardiac, and Neurological Care

The AMA also introduced codes addressing critical care technologies and advanced monitoring solutions.

Respiratory Support Innovation

• 1027T–1029T — Transvenous phrenic neurostimulation therapy designed to activate the diaphragm in ventilated patients.

This technology supports ventilator-dependent individuals and may help reduce complications associated with prolonged mechanical ventilation.

Cardiac Monitoring Enhancements

• 1050T–1053T — Subcutaneous monitoring systems for heart failure decompensation, enabling earlier detection of clinical deterioration and proactive care management.

AI and Algorithm-Driven Analysis

• 1041T — Algorithmic analysis of encephalographic waveforms, highlighting the integration of artificial intelligence in clinical decision support.

Urology and Skin Substitute Applications

Additional codes include:

• 1042T — Add-on code for implantation of an absorbable urologic scaffold used in prosthetic urethra restoration during bladder neck and urethral reconstruction (reported with CPT codes 55840, 55842, 55845, or 55866).
• 1044T–1049T — New skin substitute application codes reflecting advances in wound management and regenerative tissue technologies.

Revisions to Existing Category III Codes

In addition to new code creation, the AMA revised four existing codes to improve clarity and reporting accuracy.

Vena Cava Valve Implantation Clarifications (0805T–0806T)

The descriptors now specify that these codes represent transcatheter superior and/or inferior vena cava prosthetic valve implantation.

Key reporting guidance includes:

• Transseptal puncture is not included.
• Diagnostic right heart catheterization should not be reported separately unless:
  • Performed during a distinct session
  • Clinical necessity is documented
  • Modifier 59 is appended.

Descriptor Changes to 0882T and 0883T

These codes were revised to:

• Remove the term “upper extremity”
• Clarify related services that may be reported concurrently

Such revisions help reduce coding ambiguity and improve consistency in reporting.

Reimbursement Considerations: Coverage Is Not Guaranteed

A critical point for providers and billing teams is that inclusion in the CPT® code set does not automatically result in payer coverage or reimbursement.

Before performing services associated with Category III codes, practices should:

• Verify payer policies
• Confirm coverage requirements
• Obtain prior authorization when applicable
• Document medical necessity thoroughly
• Monitor payer guidance for evolving reimbursement decisions

Failure to verify coverage may lead to claim denials or unexpected patient financial responsibility.

Why Reporting Category III Codes Supports Medical Advancement

Even when reimbursement is uncertain, reporting these codes remains essential. Category III code utilization:

• Demonstrates real-world clinical use
• Provides utilization data to payers
• Supports evidence development
• Helps establish clinical effectiveness
• Facilitates FDA review processes
• Accelerates transition to permanent Category I codes

In short, accurate reporting helps move emerging technologies from experimental use to mainstream clinical practice.

What This Means for Healthcare Organizations

The expansion of Category III codes reflects broader industry trends:

• Growth in precision medicine and personalized care
• Rapid adoption of AI-driven diagnostics
• Increased use of digital modeling and simulation
• Expansion of minimally invasive therapies
• Greater focus on remote monitoring and predictive care

For healthcare revenue cycle teams, these changes require:

• Ongoing coder education
• Careful documentation practices
• Updated charge capture workflows
• Strong payer policy monitoring
• Strategic financial planning for emerging services

Organizations that proactively adapt to these changes will be better positioned to support innovation while maintaining financial stability.

Stay Ahead of CPT® Changes with Expert Medical Coding Support

Keeping pace with evolving CPT® updates — especially emerging Category III codes — can be challenging for healthcare organizations. From understanding new reporting requirements to ensuring proper documentation and payer compliance, even small coding gaps can lead to denials, lost revenue, and audit risks.

At Bristol Healthcare, we help practices navigate complex coding updates with confidence.

Our certified medical coding specialists stay continuously updated on AMA changes, regulatory developments, and payer policies to ensure accurate reporting of both established and emerging services. Whether your organization is adopting new technologies, introducing innovative procedures, or managing complex specialty workflows, our expert team ensures compliant coding, optimized reimbursement opportunities, and streamlined revenue cycle performance.

Our coding services help your practice:

• Accurately report new and emerging CPT® services
• Reduce claim denials and compliance risks
• Improve documentation integrity
• Maximize appropriate reimbursement opportunities
• Stay current with regulatory and payer requirements
• Support adoption of innovative clinical technologies

Partner with Bristol to strengthen coding accuracy, improve financial outcomes, and position your organization for long-term success in an increasingly complex healthcare environment.