Cat 3 reimbursement code rejected, page-58

From the evolution research report.

For the Miscellaneous Reimbursement code, approval rates for reimbursement claims range from 20% to 40% - relatively low compared to Category III and Category I codes. This is because miscellaneous codes are generally less standardised, require more rigorous justification for use, and often involve case-by-case approval processes by insurers. Material revenue uplift is expected upon achieving a dedicated Category III CPT code.

Category III CPT codes are assigned to new and emerging technologies and typically receive higher reimbursement approval rates from insurers, usually between 4060%. Echo IQ has filed an application for a Category III CPT code with the Centers for Medicare & Medicaid Services (CMS) and anticipates receiving approval by mid-2025. This code will streamline the reimbursement process, boosting both institutional adoption rates and overall revenue generation as healthcare providers experience greater confidence and predictability in reimbursement claims.

The most substantial revenue enhancement is projected following the eventual receipt of a Category I CPT code. Category I codes signify widespread clinical acceptance and usage and typically result in the highest approval rates for reimbursement claims, generally between 80-100%. The achievement of a Category I CPT code not only enhances the reimbursement approval rate substantially but also typically increases the reimbursable amount, further improving Echo IQ's revenue potential.