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FH® Category III to Provide Benchmark Charge Values for Category III Codes Beginning in May

New Addition to FAIR Health’s Charge Benchmark Products

FH® Category III, a new addition to FAIR Health’s suite of FH Charge Benchmarks, will be launched at the end of May. The product will provide benchmark charge values for Category III CPT® codes, temporary codes published by the American Medical Association for emerging technologies, services, procedures and service paradigms. FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information.

“To reflect our commitment to transparency, we look for ways to value procedures for which data have never before been available to the market,” said FAIR Health President Robin Gelburd. “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.”

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 FAIR Health’s 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.

About FAIR Health

FAIR Health is a national, independent nonprofit organization that qualifies as a public charity under section 501(c)(3) of the federal tax code. It is dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation’s largest collection of commercial healthcare claims data, which includes over 49 billion claim records and is growing at a rate of over 3 billion claim records a year. FAIR Health licenses its commercial data and data products—including benchmark modules, data visualizations, custom analytics and market indices—to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D, which accounts for a separate collection of over 49 billion claim records; FAIR Health includes among the commercial claims data in its database, data on Medicare Advantage enrollees. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. FAIR Health’s systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 Type 2 compliance by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers’ compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish, which enables consumers to estimate and plan for their healthcare expenditures and offers a rich educational platform on health insurance. An English/Spanish mobile app offers the same educational platform in a concise format and links to the cost estimation tools. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger’s Personal Finance. For more information on FAIR Health, visit fairhealth.org.

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FH® Category III to Provide Benchmark Charge Values for Category III Codes Beginning in May

New Addition to FAIR Health’s Charge Benchmark Products

About FAIR Health

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