The Case is Made for New CPT Codes
The Challenge
A ground-breaking medical device, although recognized by major clinical compendia, was lacking the appropriate Current Procedural Terminology (CPT) codes. This created hesitancy among providers, who feared they would not be reimbursed or prescribing this supportive care technology for their patients.
The IP Solution
IP developed and executed a multi-pronged strategy to support the approval of a CPT code for the medical device. Beginning with a strategy to obtain a temporary Category III CPT Code, our team worked closely with the manufacturer to author and submit an article to a peer-reviewed publication. It addressed the importance of the work and direct involvement needed on the part of physicians, to support the use of the device. Following the publication of the article, our team delivered the guidance and support needed to submit an application to the American Medical Association (AMA) for a new CPT code. Additionally, we engaged influential physicians and thought leaders within the supportive care space to advocate for the product and create awareness among providers and patients.
Months of persistence paid off and the AMA accepted the company’s application for a Category III CPT Code, a significant step to ensure access for cancer and chemotherapy patients across the US. However, in order to secure access, continued efforts to secure a permanent CPT I code needed to be made. Our team continued to support our client as the generated high-quality clinical evidence and associated publications to demonstrate clinical efficacy, safety, and improved outcomes. A targeted effort to engage community providers helped them to achieve widespread clinical adoption and specialty societies were engaged to build endorsement and backing for the technology. Finally, a CPT I application was submitted to AMA including strong clinical evidence, data, literature, and specialty society endorsement.
IP continues to be critical in our US strategy. From day one they have worked closely with [us] as an extended part of our company, understanding our challenges and working with us to find solutions putting a clear strategy in place and ultimately delivering on their word. Our relationship is incredibly strong.
The Results
As a result of this strategy, the company successfully transitioned from a CPT III to a CPT I code, driving increased physician adoption and payer confidence. The establishment of standardized reimbursement unlocked broader coverage, leading to higher utilization and accelerating demand across multiple clinical settings. Strategically, CPT I status validated the technology as standard of care, strengthening the company’s competitive status, improving commercial scalability, and supporting sustainable revenue growth.