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HCPCS C8004 · Level II · C code

C8004: Sim ang w/prs cath rad emb, 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 C8004

Medicare payment
$11,794.23
OPPS rate, SI J1
Coverage code
D
special coverage instructions apply
Facility outpatient MUE
1
MAI 3
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

C8004 is a Level II code from the C section (hospital outpatient prospective payment system, temporary codes), in use since 2025: "Simulation angiogram with use of a pressure-generating catheter (e.g., one-way valve or occlusion balloon, intermittently or temporarily occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the angiogram, for subsequent therapeutic radioembolization of tumors". Hospital outpatient departments are paid $11,794.23 for C8004 under status indicator J1, APC 5193 (Level 3 Endovascular Procedures), minimum unadjusted copayment $2,358.85 (October 2026 Addendum B). Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). C8004 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. HCPCS record: BETOS P1G (major procedure - other); pricing indicator 53; type of service 2 (surgery). Nearby codes: C8003, C8007, C8000, C8008.

C8004 descriptor and code status

The October 2026 HCPCS Level II file describes C8004 as “Simulation angiogram with use of a pressure-generating catheter (e.g., one-way valve or occlusion balloon, intermittently or temporarily occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the angiogram, for subsequent therapeutic radioembolization of tumors”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes.

HCPCS file attributes of C8004
FieldValue
Short descriptorSim ang w/prs cath rad emb
Added to HCPCS2025-04-01
Last actionC (long description changed), effective 2026-10-01
Coverage codeD: special coverage instructions apply
Pricing indicator53: statute
BETOS categoryP1G: major procedure - other
Type of service2: surgery
Statute1833(t)

Medicare payment for C8004

Hospital outpatient departments are paid $11,794.23 for C8004 under status indicator J1, APC 5193 (Level 3 Endovascular Procedures), minimum unadjusted copayment $2,358.85 (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 5193 (Level 3 Endovascular Procedures), national unadjusted payment $11,794.23 with a minimum unadjusted copayment of $2,358.85.

Ambulatory surgical center (Addendum AA)

Payment indicator J8 (Device-intensive procedure; paid at adjusted rate), national rate $7,438.31 at a payment weight of 132.0676. The multiple-procedure discount applies when it is billed with another ASC procedure.

Medically Unlikely Edits for C8004

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). The facility outpatient MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for C8004 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalNature of Service/Procedure
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for C8004 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists C8004 in v323r0.

C8004 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 C8004 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C8004

No current LCD or billing and coding article lists C8004. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on C8004

CARC 50 · N115

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

CARC 151 · N362

units of C8004 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 C8004 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C8004 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 C8004

What does HCPCS code C8004 describe?

"Simulation angiogram with use of a pressure-generating catheter (e.g., one-way valve or occlusion balloon, intermittently or temporarily occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the angiogram, for subsequent therapeutic radioembolization of tumors" (short descriptor "Sim ang w/prs cath rad emb"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2025-04-01; last action C (long description changed) effective 2026-10-01.

Is C8004 a CPT code?

No. C8004 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for C8004?

Hospital outpatient departments are paid $11,794.23 for C8004 under status indicator J1, APC 5193 (Level 3 Endovascular Procedures), minimum unadjusted copayment $2,358.85 (October 2026 Addendum B).

How many units of C8004 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). For the facility outpatient MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover C8004?

C8004 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.

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.