Specific criteria for Category I codes

Specific criteria for Category I codes

A proposal for a new or revised Category I code must satisfy all of the following criteria:

  • All devices and drugs necessary for performance of the procedure or service have received FDA clearance or approval when such is required for performance of the procedure or service.
  • The procedure or service is performed by many physicians or other qualified health care professionals across the United States.
  • The procedure or service is performed with frequency consistent with the intended clinical use (i.e., a service for a common condition should have high volume).
  • The procedure or service is consistent with current medical practice.
  • The clinical efficacy of the procedure or service is documented in literature that meets the requirements set forth in the CPT code-change application.
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