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HCPCS C8937 · Level II · C code

C8937: Computer-aided detection, 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 C8937

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
2
MAI 2
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
5
3 hospital outpatient
LCDs and articles
0 / 0
add-on code

TL;DR

CMS describes HCPCS C8937, added in 2019, as "Computer-aided detection, including computer algorithm analysis of breast mri image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)". None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C8937; its HCPCS pricing indicator is 53 (statute). MUE limits for C8937: practitioner 2 (MAI 2, Anatomic Consideration); hospital outpatient 2 (MAI 2, Anatomic Consideration). C8937 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 6 primary codes such as 77046, 77047, C8903, C8905. In the NCCI PTP files v323r0 C8937 appears in 3 practitioner pairs as column 2 and 2 as column 1 (most often with 0694T, 76376, 76377), and in 3 hospital outpatient pairs as column 2 and 0 as column 1. No current LCD or billing article lists C8937; its HCPCS coverage code is D (special coverage instructions apply). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS I2D (advanced imaging - MRI/MRA: other); pricing indicator 53; type of service 4 (diagnostic radiology). Nearby codes: C8930, C8929, C8928, C8924.

C8937 descriptor and code status

The October 2026 HCPCS Level II file describes C8937 as “Computer-aided detection, including computer algorithm analysis of breast mri image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes. Although searches often call it the "C8937 CPT code", C8937 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of C8937
FieldValue
Short descriptorCad breast mri
Added to HCPCS2019-01-01
Last actionN (no maintenance), effective 2019-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator53: statute
BETOS categoryI2D: advanced imaging - MRI/MRA: other
Type of service4: diagnostic radiology
Cross-reference0159T (CPT)
Statute1833(t)

Medicare payment for C8937

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C8937; 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 N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for C8937

MUE limits for C8937: practitioner 2 (MAI 2, Anatomic Consideration); hospital outpatient 2 (MAI 2, Anatomic Consideration). The practitioner 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 C8937 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services22 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital22 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for C8937 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, C8937 is the column-2 (bundled) code in 3 active pairs, 100% of which allow a modifier and the column-1 code in 2 (0% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with C8937 (practitioner)
Column-1 codePairs
0694T (CPT; descriptor licensed by AMA)1
76376 (CPT; descriptor licensed by AMA)1
76377 (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into C8937 (practitioner)
Column-2 codePairs
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, C8937 is the column-2 (bundled) code in 3 active pairs, 100% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with C8937 (hospital outpatient)
Column-1 codePairs
0694T (CPT; descriptor licensed by AMA)1
76376 (CPT; descriptor licensed by AMA)1
76377 (CPT; descriptor licensed by AMA)1

C8937 is an add-on code: it is payable only with a primary service on the same claim (77046, 77047, C8903, C8905, C8906, C8908). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check C8937 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C8937

No current LCD or billing and coding article lists C8937. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on C8937

CARC 50 · N115

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

CARC 151 · N362

units of C8937 exceed the practitioner MUE of 2 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 C8937 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C8937 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 C8937

What does HCPCS code C8937 describe?

"Computer-aided detection, including computer algorithm analysis of breast mri image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)" (short descriptor "Cad breast mri"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2019-01-01.

Is C8937 a CPT code?

No: CMS maintains C8937 in HCPCS Level II, while the AMA maintains CPT. People do search "C8937 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for C8937?

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C8937; its HCPCS pricing indicator is 53 (statute).

Is C8937 an add-on code?

C8937 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 6 primary codes such as 77046, 77047, C8903, C8905.

How many units of C8937 can be billed per day?

MUE limits for C8937: practitioner 2 (MAI 2, Anatomic Consideration); hospital outpatient 2 (MAI 2, Anatomic Consideration). For the practitioner MUE (MAI 2), units above 2 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover C8937?

No current LCD or billing article lists C8937; its HCPCS coverage code is D (special coverage instructions apply).

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.