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Coding Guidance Request Form

Coding Guidance Request Form deadline is January 19, 2024, to be considered for the February 25, 2024, in-person meeting.

* Denotes required fields.

All form fields with * are required

Type of Request: *

Coding Advice

New/Revised Category I or Category III CPT Code

Will you be submitting a Code Change Application to the CPT Editorial Panel regarding this request?: *

Yes

Unsure

If yes, Which CPT Editorial Panel Meeting will you be submitting a Code Change Application for?:

Company Name: *

Address Line 1: *

Address Line 2:

City: *

State/Province/Region: *

Postal/Zip Code: *

Country: *

Contact Person: *

Email: *

Phone: *

Name of Treatment/Service/Product Device: *

What urologic condition does this treat?: *

Briefly describe treatment and how it is utilized: *

Has FDA approval been granted?: *

Yes

If yes, when was the approval granted?:

If no, when is the anticipated approval date?:

Is there published peer-reviewed English-language literature published?: *

Yes

The AUA requests any marketing materials, peer-reviewed literature and any other information to assist in providing a full picture of the treatment/procedure/service/device and the purpose of the request. Please upload your information here. If you have additional materials, please indicate in the block below and when contacted after receipt of this request, additional information can be provided.

File Attachments

(Note: The filename should not should contain any punctuation, special or foreign characters.)

Allowed file types: PDF, PNG, JPG, JPEG, GIF, DOCX, DOC

The maximum total file size for all documents should be less than 4MB. Total file size submissions exceeding 4MB may result in an error and delays with processing your application. (El tamaño máximo de archivo total para todos los documentos debe ser inferior a 4 MB. El total de envíos de archivos que superen los 4 MB puede ocasionar un error y demoras en el procesamiento de la aplicación.)

1. Marketing Materials, Peer-Review Literature and any other Information:

2. Marketing Materials, Peer-Review Literature and any other Information:

3. Marketing Materials, Peer-Review Literature and any other Information:

4. Marketing Materials, Peer-Review Literature and any other Information:

Does additional information need to be submitted?:

Yes

If a new CPT code is required, has the American Medical Association CPT website been reviewed?: *

Yes

The AUA will host three CRC meetings per calendar year. These meetings are being aligned with the CPT Editorial Panel Code Change Application Deadlines:

Upcoming CRC Meetings	CPT Editorial Panel Code Change Application Deadline	CPT Editorial Panel Meeting
August 1, 2024 (Virtual)	November 1, 2024	February 6-8, 2025
November 2024 (TBD)	February 10, 2025	May 1-3, 2025
March 2, 2025 (In-person, Washington, DC)	June 11, 2025	September 18-20, 2025

Coding Guidance Request Form

File Attachments

American Urological Association

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