Thanks to the CAP’s hard work and advocacy, physicians providing Chimeric Antigen Receptor T-Cell (CAR-T) Therapy, a treatment for certain types of cancer, received exciting news earlier in July: new billing codes and defined payment for their work. The CMS released the 2025 Medicare Physician Fee Schedule Proposed Rule, which included four new CPT codes to describe the procedures required for creating and administering CAR-T therapy. The CMS also established Relative Value Units (RVUs) to compensate physicians for their work related to these services. The establishment of these new codes and RVUs were the result of a multiyear effort led by the CAP.

At the May 2023 American Medical Association (AMA) CPT Editorial Panel meeting, the CAP and a multispecialty group successfully advocated for the addition of four new CPT codes to report CAR-T services and added a new subsection in the CPT manual with reporting guidelines. The codes were created as Category III codes in 2018.

The new CPT codes are:

• 3X018 Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day
• 3X019 Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage)
• 3X020 Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration
• 3X021 Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous

CAP Leads Multispecialty Effort

To ensure these services were appropriately valued, the CAP led a multispecialty effort to develop and present RVU recommendations at the September 2023 AMA RUC meeting. As outlined in the proposed 2025 Medicare Physician Fee Schedule, the CMS proposed the RUC recommended work RVUs for all four CAR-T services. The CAP is pleased with this result and will urge the CMS to finalize the proposed RUC recommendations for physician work.

The AMA will assign and publish the new specific code numbers in late summer/fall for use starting January 1, 2025. Physicians will still need to use the CPT Category III temporary codes (0537T-0540T) to report the services for the rest of this calendar year.