Welcome to The Coding Corner, a space where doctors who are already excellent at doctoring can dig into the finer details of coding, documentation, compliance, and the occasional mystery that is the AMA Evaluation and Management (E/M) grid. Each month, Tonya Reynoldson, OD, brings forward real-world coding questions we commonly hear in eyecare practices, and she and Sarah Haney break them down from both clinical and coding perspectives.
This month, we’re exploring T codes and how practices can understand, develop, and maintain reimbursement for technologies, services, and more when using them.
Tonya: Sarah, first things first. What exactly is a “T code”?
Sarah: Think of the “T” as temporary. Category III CPT codes (aka T Codes) are temporary codes for emerging technologies, services, procedures, and service paradigms. They also give us something an unlisted code cannot: a way to collect specific data on utilization and outcomes.1
Tonya: Does every T code eventually “graduate” to a permanent CPT code?
Sarah: Nope! Some may eventually become Category I codes; others may be revised, extended, or archived. Generally, a Category III code is archived 5 years after publication or extension unless its archival date is modified. If it converts to Category I, CPT provides a cross-reference to the new code.2
Tonya: What about reimbursement? If it pays well today, can I count on that tomorrow?
Sarah: Not quite. T codes don’t have nationally assigned relative value units, so reimbursement is largely payer-driven and can vary significantly. For example, Medicare pricing for 0563T (TearCare) is determined locally by each CMS Medicare administrative contractor.3 Some payers may consider the service investigational or noncovered, which makes it a patient out-of-pocket expense, while others may cover the service and reimburse according to their own policy and fee schedule. When coverage is unknown, I recommend providing the appropriate advance notice to the patient, such as an advance beneficiary notice for Medicare Part B or an applicable notice of noncoverage, before the service is performed.
Practices should establish a usual and customary fee for the service and charge it consistently, rather than adjusting the charge based on what a particular payer reimburses. If you are contracted with a payer, you must also follow the terms of that contract, including filing the claim and accepting the contracted rate when applicable.
Tonya: Final advice?
Sarah: Don’t forget to update your T-Code billing expectation (especially one you are using often)! Historically, Category III codes were released twice a year, but even that process is changing. The AMA is moving to 3 releases per year,1 which is even more reason for practices to stay current. Codes, descriptors, instructions, effective dates, coverage, and reimbursement can all change. Review current CPT guidance and payer policy regularly, because what worked last year (or even last quarter) may not work today!
References
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American Medical Association. Category III codes. August 7, 2026. Updated October 2, 2026. Accessed October 13, 2026.
https://www.ama-assn.org/practice-management/cpt/category-iii-codes -
American Medical Association. FAQs: CPT codes & health tech innovation. August 7, 2026. Accessed October 13, 2026.
https://www.ama-assn.org/practice-management/cpt/faqs-cpt-codes-health-tech-innovation -
American Academy of Ophthalmology. Fact sheet: coding for TearCare System. American Academy of Ophthalmic Executives. Accessed October 13, 2026. https://www.aao.org/Assets/2c3f9754-4cde-4d5d-8794-2306a7b2facb/638991713691970000/tearcare-fs-0563t-pdf?inline=1
