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BLUECONNECT
Providers
May 2024
In This Issue
► May news: Executive summary
► Now available: Annual fee schedule updates (effective July 1)
► New! AZ Pediatric Psychiatry Access Line
► New Category III code policy starts July 1
► Complimentary CNE/CME opportunity for maternity care providers
► Update your system to remove these obsolete drug codes
New Category III code policy starts July 1 
AZ Blue considers most Category III codes to be experimental, investigational, or unproven and not medically necessary because of insufficient evidence of efficacy. For this reason, we have created a Category III medical policy for your reference. All codes included in the policy will be denied (we currently deny many of them). 

Certain other Category III codes are addressed in various other medical policies and are reimbursed in accordance with those clinical guidelines. Those specific Category III codes are not included in our new Category III policy.
Applicable benefit plans
Our new Category III policy applies to our commercial plans, including Federal Employee Program® (FEP®) plans. It does not apply to our Medicare Advantage plans. 
Purpose and lifespan of Category III codes
Category III CPT codes are temporary codes that identify and collect data for emerging technology, services, and procedures. Category III codes have four numeric characters, followed by the letter T. They may or may not eventually receive a Category I CPT code. 

Five years from the date the code is issued, it will generally be archived unless a modification of the archival date is specifically noted at the time of a revision or change to the code. 

Note: Services and procedures described by archived Category III codes must be reported using the Category I unlisted code unless another specific cross-reference is established at the time of archiving.  
Preview the policy
Please invite your clinical and administrative support teams to preview the AZ Blue Category III policy after June 1, when we post it in our AZ Blue Proprietary Medical Policies search tool. This policy is a collection of the Category III codes that we already or will begin to deny under the terms of our members’ benefit plans, for the reasons explained above. We have created this policy as a convenient reference for providers.  
Questions?
If you have questions about the new Category III policy, contact us at 602-864-4320 or 1-800-232-2345, ext. 4320.  
In This Issue
► May news: Executive summary
► Now available: Annual fee schedule updates (effective July 1)
► New! AZ Pediatric Psychiatry Access Line
► New Category III code policy starts July 1
► Complimentary CNE/CME opportunity for maternity care providers
► Update your system to remove these obsolete drug codes
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