2023 CPT Changes for Radiology: A First Look

June 20, 2022

By: Stacey Hall, RHIT, CPC, CCS-P, RCC, Senior Director, Corporate Coding

If you’re anticipating the code changes for 2023, the ACR published a list of the changes, as well as early release Category III codes in the March/April 2022 ACR Radiology Coding Source™.

Here, we’ve summarized four new Category III codes that have been released early and will go into effect on July 1, 2022, for CT Tissue Characterization and Quantitative MRCP.  See below, four codes and guideline revisions radiologists can expect 2023:

  • Only two new sets of Category I CPT codes will be created for 2023, one set for percutaneous arteriovenous fistula creation and one set for neuromuscular ultrasound.
  • Revisions will be made to CPT codes for somatic nerve injection, pulmonary angiography, and paravertebral spinal nerves and branches section.
  • A new AI taxonomy appendix will be added to CPT.
  • Revisions will be made to the E/M code section for non-office/outpatient services to correspond with changes made in 2021 to the office/outpatient E/M services.

The anticipated code changes are outlined below:

Category III

These are a set of temporary codes for emerging technology, services, procedures, and service paradigms.  Category III codes allow data collection for these services/procedures.  If a Category III code is available, this code must be reported instead of a Category I unlisted code.  The use of the codes in this section allows physicians and other qualified health care professionals, insurers, health services researchers, and health policy experts to identify emerging technology, services, procedures, and service paradigms for clinical efficacy, utilization, and outcomes.  A service/procedure assigned a Category III code does not guarantee recognition or reimbursement from third party payers.

The following codes relevant to radiology will be made available July 1, 2022.  (See the AMA website for a full list of Cat III codes effective in July)

CT Tissue Characterization

Quantitative CT tissue characterization is a new technology that can improve population health strategies and lead to better patient outcomes by using computer algorithms to quantitatively characterize tissues on CT images that could only be subjectively evaluated in the past.

Two new codes were created to describe this service. 

Quantitative MRCP

Quantitative MRCP (QMRCP) is the quantitative evaluation of pancreato-biliary structure anatomy from MR images that produces quantitative data of the biliary tree and pancreatic ducts.  The data can inform radiologist evaluation and interpretation, aid physician decision making, and potentially reduce the time for initiation of targeted treatments and interventions in diseases, such as cholestatic liver disease, chronic pancreatitis, or gallstones.

Two new codes were created to describe this service.

Parenthetical notes state that QMRCP cannot be reported in conjunction with 3D post-processing (76376 or 76377). 

2023 CPT Code Changes

Please note, while this summary lists the code changes that are proposed, codes are not assigned, nor exact wording finalized until just prior to final CPT publication in the fall.

New codes will be created effective January 1, 2023, for the following:

Percutaneous Arteriovenous Fistula Creation

Two new codes will be available for percutaneous or endovascular approaches for creating arteriovenous anastomoses.

The new codes will allow the reporting of less invasive approaches utilizing endovascular methods, such as magnets or mechanical capture, to approximate the target vein and artery.  The different endovascular procedures may also use balloons or coils to direct blood flow, as well as different imaging methods to guide the endovascular procedure.

Neuromuscular Ultrasound

A new code will be available to report comprehensive ultrasound of nerves and accompanying structures. 

The descriptor for existing code 76882 (US joint or other nonvascular extremity structures) will be revised to include the phrase “focal evaluation of,” and the guidelines will be revised to clarify the reporting of these two codes.

Revisions will also be made to existing codes and will also be effective January 1, 2023, for the following:

Somatic Nerve Injection

The somatic nerve injection codes (64415-64417 and 64445-64448) will be revised to include imaging guidance when performed.

Pulmonary Angiography

The pulmonary angiography code (93568) will be revised to specifically state it is for nonselective angiography performed on the pulmonary artery.

Paravertebral Spinal Nerve

Several changes will be made to this subsection in CPT.  Changes include:

  • Revision of guidelines to clarify the procedures described by codes 64490-64495
  • A table will be added with instructions on appropriate reporting of these codes
  • New parenthetical notes will be added to provide instruction on the unilateral and bilateral reporting of paravertebral facet injection of the T12-L1 and L1-L2 levels or nerves innervating those joints
  • The parenthetical notes following codes 64492 and 64495 that instruct these codes not to be reported more than once per day will be deleted
  • The parenthetical notes regarding the reporting of codes 64490-64495, 20552, 20553, and 0213T-0218T will be deleted

New Artificial Intelligence (AI) Taxonomy Appendix

According to the ACR, a new appendix will be added to the CPT 2023 code book that describes various applications of AI, such as expert systems, machine learning, and algorithm-based medical services and procedures which will be classified into one of three categories:

  • Assistive
  • Augmentative
  • Autonomous

The new taxonomy will help to improve understanding of AI and clarify how these services are used by physicians or other qualified health professionals.

Evaluation and Management

The most highly anticipated changes are in relation to E/M for non-office/outpatient services (office/outpatient services were revised in 2021).  Below are some of the most pertinent changes.  Zotec will provide detailed education material regarding these updates as 2023 approaches.

  • Revisions to guidelines will take place for the following E/M services:
    • Inpatient and Observation Care Services
    • Consultations
    • Emergency Department Services
    • Nursing Facility Services
    • Home and Residence Services
    • Prolonged Services
  • Subsection regarding Concurrent Care and Transfer of Care will be deleted

Inpatient and Observation Care Services

  • Revision to guidelines
  • Revision of codes 99221-99223, 99231-99236, 99238-99239 to include observation care services
  • Deletion of codes 99217-99220 and 99224-99226


  • Revision to guidelines
  • Revision of codes 99242-99245 and 99252-99255
  • Deletion of codes 99241 and 99251

Emergency Department Services

  • Revision to guidelines
  • Revision of codes 99281-99285

Nursing Facility Services

  • Revision of codes 99304-99310
  • Deletion of code 99318

Home and Residence Services

  • Revision to guidelines
  • Revision of codes 99341, 99342, 99344, 99345, and 99347-99350
  • Deletion of codes 99324-99328, 99334-99337, 99339, 99340, and 99343

Prolonged Services

  • Revision to guidelines
  • Creation of two new codes for prolonged services and prolonged psychotherapy services
  • Revision of codes 99417 and 99483
  • Deletion of codes 99345 and 99355-99357

Stay tuned for more radiology coding updates from Zotec Partners, especially as we continue to track and research upcoming E/M code changes to the specialty in 2023.