CPT Code Identification

Find the codes that actually pay: Category I, Category III, modifiers, and the payer policies behind each. Without this, your sales motion stalls at the billing department.

Overview

Reimbursement determines whether your customer can use your product more than once. A device with no clear CPT path becomes a budget request, not a routine purchase. Even a great clinical product can stall here.

We map your product to the right combination of Category I, Category III, HCPCS, and modifier codes; assess each major payer's coverage policy; and document the path from procedure to paid claim, including where your customer will need a prior authorization.

Our Process

  1. 1

    Use-case decomposition

    Map every clinical scenario in which your product is used: the device, the procedure, the site of service, the rendering provider.

  2. 2

    Code candidate sourcing

    Pull candidate Category I, Category III, and HCPCS codes for each scenario.

  3. 3

    Payer coverage scan

    Check Medicare LCDs, top 5-10 commercial payers, and Medicaid policies for each code candidate.

  4. 4

    Decision matrix

    Combine codes by scenario with documented rationale and known gaps.

  5. 5

    Sales enablement

    Translate findings into a billing guide that customers can hand to their revenue cycle team.

Frequently Asked Questions

What if no Category I code fits?

We map the Category III path and document the pros/cons of staying there vs. pursuing a new Category I via AMA, including realistic timelines.

Do you talk to payers directly?

We summarize public policy and draft outreach materials; direct payer negotiation is a separate engagement.

How current is the policy data?

We work from the most recent publicly available LCDs and payer policies, with dates cited on every reference.

Can you handle international codes too?

US-first. We can extend to UK NHS tariffs and EU country codes as a follow-on engagement.

Find the codes that make your product reusable.

Tell us your product, clinical scenarios, and target payers. We will return a code matrix and policy scan within four weeks.

Start a Conversation