Key facts for C1605
- Medicare payment
- none in these files
- no PFS, DMEPOS, CLFS, OPPS or ASC amount; pricing indicator 53
- Coverage code
- D
- special coverage instructions apply
- Practitioner MUE
- 1
- MAI 2
- NCCI PTP pairs
- 0
- practitioner file
- LCDs and articles
- 0 / 0
TL;DR
CMS describes HCPCS C1605, added in 2024, as "Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation". None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C1605; its HCPCS pricing indicator is 53 (statute). MUE limits for C1605: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). C1605 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. OPPS status indicator H: Pass-through device categories. HCPCS record: BETOS D1A (medical/surgical supplies); pricing indicator 53; type of service 9 (other medical items or services), S (surgical dressings or other medical supplies). 5 other active codes open with "Pacemaker"; related codes: C1785, C1786, C2619, C2620.
C1605 descriptor and code status
The October 2026 HCPCS Level II file describes C1605 as “Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes.
| Field | Value |
|---|---|
| Short descriptor | Pmkr, dual, leadless |
| Added to HCPCS | 2024-07-01 |
| Last action | N (no maintenance), effective 2024-07-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 53: statute |
| BETOS category | D1A: medical/surgical supplies |
| Type of service | 9: other medical items or services; S: surgical dressings or other medical supplies |
| Statute | 1833(t) |
Medicare payment for C1605
None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C1605; its HCPCS pricing indicator is 53 (statute). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.
Hospital outpatient (OPPS Addendum B)
Status indicator H (Pass-through device categories), APC 2046 (Pmkr, dual, leadless), with no separate OPPS payment rate.
Ambulatory surgical center (Addendum BB)
Payment indicator N1 (Packaged service/item; no separate payment made).
Medically Unlikely Edits for C1605
MUE limits for C1605: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
The MUE lookup for C1605 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
No active practitioner PTP pair lists C1605 in v323r0.
C1605 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.
Pair counts show exposure, not the answer for one claim. Check C1605 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for C1605
No current LCD or billing and coding article lists C1605. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.
Denials to expect on C1605
the modifier reported is inconsistent with the code
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for C1605 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C1605 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS C1605
What does HCPCS code C1605 describe?
"Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation" (short descriptor "Pmkr, dual, leadless"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2024-07-01.
Is C1605 a CPT code?
No: CMS maintains C1605 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.
What does Medicare pay for C1605?
None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C1605; its HCPCS pricing indicator is 53 (statute).
How many units of C1605 can be billed per day?
MUE limits for C1605: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.
Does Medicare cover C1605?
C1605 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- ASC Addendum BB (covered ancillary services), October 2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC BB.txtSHA-256 63cdd7c72aba7a25…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
Disclaimer
This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.