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HCPCS C8003 · Level II · C code

C8003: Imp extar knee shck absrb, HCPCS Level II C code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for C8003

Medicare payment
$17,913.59
OPPS rate, SI J1
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Facility outpatient MUE
1
MAI 2
OPPS status
SI J1
Hospital Part B services paid through a comprehensive APC
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS C8003, added in 2025, as "Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy)". Hospital outpatient departments are paid $17,913.59 for C8003 under status indicator J1, APC 5116 (Level 6 Musculoskeletal Procedures), minimum unadjusted copayment $3,582.72 (October 2026 Addendum B). CMS caps C8003 at practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy) units per day in the 2026 Q4 MUE tables. No current LCD or billing article lists C8003; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). HCPCS record: BETOS P3D (major procedure, orthopedic - other); pricing indicator 11; type of service 2 (surgery). Nearby codes: C8004, C8000, C8007, C8008.

C8003 descriptor and code status

The October 2026 HCPCS Level II file describes C8003 as “Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy)”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes.

HCPCS file attributes of C8003
FieldValue
Short descriptorImp extar knee shck absrb
Added to HCPCS2025-01-01
Last actionN (no maintenance), effective 2025-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryP3D: major procedure, orthopedic - other
Type of service2: surgery

Medicare payment for C8003

Hospital outpatient departments are paid $17,913.59 for C8003 under status indicator J1, APC 5116 (Level 6 Musculoskeletal Procedures), minimum unadjusted copayment $3,582.72 (October 2026 Addendum B). 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 J1 (Hospital Part B services paid through a comprehensive APC), APC 5116 (Level 6 Musculoskeletal Procedures), national unadjusted payment $17,913.59 with a minimum unadjusted copayment of $3,582.72.

Ambulatory surgical center (Addendum AA)

Payment indicator J8 (Device-intensive procedure; paid at adjusted rate), national rate $13,933.19 at a payment weight of 247.3845. The multiple-procedure discount applies when it is billed with another ASC procedure.

Medically Unlikely Edits for C8003

CMS caps C8003 at practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy) units per day in the 2026 Q4 MUE tables. The facility outpatient MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for C8003 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCMS Policy
Facility outpatient hospital12 Date of Service Edit: PolicyCMS Policy

The MUE lookup for C8003 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists C8003 in v323r0.

C8003 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 C8003 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C8003

No current LCD or billing and coding article lists C8003. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on C8003

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of C8003 exceed the facility outpatient MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for C8003 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C8003 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS C8003

What does HCPCS code C8003 describe?

"Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy)" (short descriptor "Imp extar knee shck absrb"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2025-01-01.

Is C8003 a CPT code?

It is not. C8003 belongs to the C section (hospital outpatient prospective payment system, temporary codes) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for C8003?

Hospital outpatient departments are paid $17,913.59 for C8003 under status indicator J1, APC 5116 (Level 6 Musculoskeletal Procedures), minimum unadjusted copayment $3,582.72 (October 2026 Addendum B).

How many units of C8003 can be billed per day?

CMS caps C8003 at practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy) units per day in the 2026 Q4 MUE tables. For the facility outpatient MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover C8003?

No current LCD or billing article lists C8003; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

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.

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.