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HCPCS C8007 · Level II · C code

C8007: Open implantation of hypoglossal nerve neurostimulator array and pulse generator, 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for C8007

Medicare payment
$31,526.06
OPPS rate, SI J1
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI J1
Hospital Part B services paid through a comprehensive APC
NCCI PTP pairs
0
practitioner file
LCDs and articles
5 / 3

TL;DR

C8007 is a Level II code from the C section (hospital outpatient prospective payment system, temporary codes), in use since 2026: "Open implantation of hypoglossal nerve neurostimulator array and pulse generator, not requiring insertion of a separate distal respiratory sensor electrode or electrode array". Hospital outpatient departments are paid $31,526.06 for C8007 under status indicator J1, APC 5465 (Level 5 Neurostimulator and Related Procedures), minimum unadjusted copayment $6,305.22 (October 2026 Addendum B). 5 active LCDs and 3 billing and coding articles list C8007 across 14 states: L35490 (Category III Codes), L36839 (Polysomnography and Other Sleep Studies), A57944, A57948. HCPCS record: BETOS P1G (major procedure - other); pricing indicator 11; type of service 2 (surgery). Nearby codes: C8008, C8004, C8003, C8000.

C8007 descriptor and code status

The October 2026 HCPCS Level II file describes C8007 as “Open implantation of hypoglossal nerve neurostimulator array and pulse generator, not requiring insertion of a separate distal respiratory sensor electrode or electrode array”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes.

HCPCS file attributes of C8007
FieldValue
Short descriptorOpn mplnt hpgls ns ary ps gn
Added to HCPCS2026-01-01
Last actionN (no maintenance), effective 2026-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryP1G: major procedure - other
Type of service2: surgery

Medicare payment for C8007

Hospital outpatient departments are paid $31,526.06 for C8007 under status indicator J1, APC 5465 (Level 5 Neurostimulator and Related Procedures), minimum unadjusted copayment $6,305.22 (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 5465 (Level 5 Neurostimulator and Related Procedures), national unadjusted payment $31,526.06 with a minimum unadjusted copayment of $6,305.22.

Ambulatory surgical center (Addendum AA)

Payment indicator J8 (Device-intensive procedure; paid at adjusted rate), national rate $27,562.80 at a payment weight of 489.3789. The multiple-procedure discount applies when it is billed with another ASC procedure.

Medically Unlikely Edits for C8007

CMS publishes no MUE for C8007 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for C8007 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists C8007 in v323r0.

C8007 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 C8007 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C8007

5 active Local Coverage Determinations and 3 billing and coding articles list C8007. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing C8007
ArticleTitleContractor(s)Related LCD
A57944Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep ApneaWisconsin Physicians Service Insurance CorporationL35490, L36839, L38527, L38528, L39246
A57948Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep ApneaNoridian Healthcare Solutions, LLCL38310
A58075Billing and Coding: Hypoglossal Nerve Stimulation for Obstructive Sleep ApneaPalmetto GBAL38276

Denials to expect on C8007

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists C8007

CARC 151 · N362

units exceed what the payer considers medically likely for one 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

Prior authorization in Original Medicare

  • WISeR model prior authorization or pre-payment review in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington for services on or after April 6, 2026; the model runs through December 31, 2031. CMS service group: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea.

Medicare Advantage plans run their own prior authorization lists. See this code on the Medicare prior authorization list.

Where QuickIntell fits for C8007 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C8007 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 C8007

What does HCPCS code C8007 describe?

"Open implantation of hypoglossal nerve neurostimulator array and pulse generator, not requiring insertion of a separate distal respiratory sensor electrode or electrode array" (short descriptor "Opn mplnt hpgls ns ary ps gn"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2026-01-01.

Is C8007 a CPT code?

No. C8007 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for C8007?

Hospital outpatient departments are paid $31,526.06 for C8007 under status indicator J1, APC 5465 (Level 5 Neurostimulator and Related Procedures), minimum unadjusted copayment $6,305.22 (October 2026 Addendum B).

Does Medicare cover C8007?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 5 active LCDs and 3 billing and coding articles list C8007 across 14 states: L35490 (Category III Codes), L36839 (Polysomnography and Other Sleep Studies), A57944, A57948.

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.