FH Category III, New FAIR Health Benchmark Product, to Be Launched in May

FH® Category III, a new addition to FAIR Health’s suite of FH Charge Benchmarks, will be launched at the end of May. Category III CPT®1 codes are temporary codes published by the American Medical Association for emerging technologies, services, procedures and service paradigms.

Category III codes, which end in “T,” are often either replaced by Category I codes or deleted within five years. Some Category III codes, however, may stay in use for longer periods. Representative services in FH Category III include:

  • Adaptive behavior assessment and treatment;
  • External electrocardiographic prolonged recording;
  • Computer-aided detection for imaging;
  • Aqueous drainage devices for glaucoma;
  • Diabetes prevention program; and
  • Platelet-rich plasma injection.

Designed for insurance and workers’ compensation markets, FH Category III is intended to help payors and third-party administrators make pricing and contracting decisions regarding professional services represented by these codes. The new product serves as a complement to our existing FH Medical module.

FH Category III provides benchmark values for the codes based entirely on actual billed charge data for each code in each of 493 geozips, geographic areas that typically track with the first three digits of a zip code. If the number of actual charges for a procedure code/geozip combination is insufficient to develop a benchmark, no information will be reported.

FH Category III will be released twice a year, at the end of May and November, with each release representing 12 months of charge data. The benchmark values will be arrayed from the 50th to 95th percentiles and include the mean (average) and mode (most frequently occurring value). Flexible formats are available to facilitate loading the data to clients’ systems.

FAIR Health President Robin Gelburd said: “To reflect our commitment to transparency, we look for ways to value procedures for which data have never before been available to the market. Grappling with Category III codes is sometimes difficult for payors and administrators, and we now offer data to help them make decisions about these codes.”

To learn more about FH Category III, contact us by email at info@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.

1. CPT © 2017 American Medical Association (AMA). All rights reserved.