3D Modeling’s Entrance into CPT Coding

Today, this work is commonly performed in US healthcare facilities. However, without a CPT code, the work isn’t recognized as a medical procedure. Under the leadership of Frank Rybicki, MD, PhD, FACR, and the team at the American College of Radiology (ACR), that work is now codified as a medical procedure, and there is an opportunity to correctly use these billing codes to deliver the data to the Centers for Medicare & Medicaid Services (CMS) that’s needed to properly reimburse for services.

Read Dr. Rybicki’s perspective on this important milestone.

Dr. Rybicki: CPT codes help standardize medical workflows for healthcare providers by aligning billing, strengthening reimbursement arguments, and establishing an evidence base for broader adoption. Because digital planning supported by 3D surface meshing is considered an emerging technology within the healthcare system, the associated CPT codes are designated as Category III. This category is intended to support data collection and clinical evaluation that will build a case for a more permanent Category I status.

Dr. Rybicki: There are favorable ways to use Category III CPT codes. How these codes are used will determine the fate of the clinical services. The right way to use Category III CPT codes is to correctly bill them to CMS with the backup cost data for the Medicare population. This effort is at least as important as the clinical and engineering effort of creating a surface mesh and then generating a clinical output from the Final Anatomic Representation. The challenge is that CPT codes are typically assigned an Ambulatory Payment Classification (APC) that does not fully cover the costs of the service. Because the CMS reimbursement is very modest, service lines fail to accurately and fully report the codes to CMS. This, in turn, leads to persistent low payment from CMS. In fact, accurate reporting of Category III CPT codes is the only way to increase reimbursement over time.

Dr. Rybicki: Healthcare facilities should use Category III CPT codes to negotiate payment from third-party payers, meaning medical insurance carriers outside CMS. However, this cannot be at the expense of accurate reporting to CMS. Both should happen for the separate patient populations. Category III CPT codes can lead to much higher payments from third-party payers, but if a provider or a healthcare facility (HCF) takes the approach of billing those third-party payers while failing to properly use the Category III CPT codes to provide data to CMS, there will never be fair reimbursement for these important services.

Embedding these codes into the healthcare facility workflow and reporting them to CMS makes today’s work with virtual surgical planning more visible, and it is the only way to reach sustainable reimbursement.

Dr. Rybicki: Each of the three new code sets covers a specific use of 3D digital modeling, plus add-on codes for additional time spent creating the 3D surface mesh files. These categories include creation of patient-specific digital 3D surface mesh models, digital simulation, including design and surgical planning, and computational modeling, such as finite-element analysis (FEA) and computational fluid dynamics (CFD).

Each code references 3D models generated from surface mesh data. The collection of final surface mesh files used for patient care is termed the Final Anatomic Representation, defined by the AMA to help describe this work as a US medical procedure.

With this context in mind, here’s a closer look at the individual codes and their intended use:

1030T and 1031T: 3D digital planning — preoperative planning
These codes cover the first 30 minutes of preoperative 3D digital planning (1030T) and each additional 30-minute increment (1031T). They include the creation, segmentation, and modification of 3D surface mesh data for preoperative planning purposes.

1032T and 1033T: 3D digital planning — computer-assisted simulation
The next set of codes represents the use of 3D surface meshes for simulation, such as virtual surgical resection, for the first 60 minutes (1032T) and following 30-minute increments (1033T). Surgical teams can virtually rehearse procedures, simulate incisions or device placements, and anticipate potential intraoperative challenges. All uses of extended reality are captured in 1032T and 1033T.

1034T and 1035T: 3D digital planning — computational analysis
Lastly, we have codes for computational analysis, such as finite element analysis (FEA) and computational fluid dynamics (CFD), both of which use 3D surface mesh files as input. The same format applies here, with the initial 90-minute session listed at 1034T and the following 30 minutes falling under 1035T. CFD can be used to predict the hemodynamic assessment of blood flow and FEA. These enable more dynamic and predictive evaluation of interactions between anatomical structures and their surrounding environment.

Dr. Rybicki: These new CPT codes are an important milestone because they create and define the initial reimbursement from CMS and third-party payers for the creation of 3D surface mesh files and their use in patient care. Surface mesh files are digital medical assets that deliver value to providers and enable more informed decision-making. Like those for 3D printing, these new codes are essential for personalized patient care in the United States.