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HCPCS C9603 · Level II · C code

C9603: Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, 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 C9603

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 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
217
211 hospital outpatient
LCDs and articles
2 / 2
add-on code

TL;DR

C9603 is a Level II code from the C section (hospital outpatient prospective payment system, temporary codes), in use since 2013: "Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (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 C9603; its HCPCS pricing indicator is 53 (statute). MUE limits for C9603: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data). C9603 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 8 primary codes such as 92933, 92937, 92941, 92943. In the NCCI PTP files v323r0 C9603 appears in 0 practitioner pairs as column 2 and 217 as column 1, and in 0 hospital outpatient pairs as column 2 and 211 as column 1. 2 active LCDs and 2 billing and coding articles list C9603 across 9 states: L33623 (Percutaneous Coronary Intervention), L34761 (Percutaneous Coronary Interventions), A56823, A57479. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS P2F (major procedure, cardiovascular - other); pricing indicator 53; type of service 2 (surgery). 1 other active code opens with "Percutaneous transluminal coronary atherectomy"; related codes: C9602, C9604, C9601, C9600.

C9603 descriptor and code status

The October 2026 HCPCS Level II file describes C9603 as “Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (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.

HCPCS file attributes of C9603
FieldValue
Short descriptorPerc d-e cor stent ather br
Added to HCPCS2013-01-01
Last actionN (no maintenance), effective 2013-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator53: statute
BETOS categoryP2F: major procedure, cardiovascular - other
Type of service2: surgery
Statute1833(t)

Medicare payment for C9603

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C9603; 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.

Ambulatory surgical center (Addendum AA)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for C9603

MUE limits for C9603: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for C9603 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital23 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for C9603 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, C9603 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 217 (76% modifier-allowed); 27 earlier pairs have been deleted.

Column-2 codes bundled into C9603 (practitioner)
Column-2 codePairs
01924 (CPT; descriptor licensed by AMA)1
01925 (CPT; descriptor licensed by AMA)1
01926 (CPT; descriptor licensed by AMA)1
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0632T (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, C9603 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 211 (100% modifier-allowed); 27 earlier pairs have been deleted.

Column-2 codes bundled into C9603 (hospital outpatient)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0632T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
11000 (CPT; descriptor licensed by AMA)1

C9603 is an add-on code: it is payable only with a primary service on the same claim (92933, 92937, 92941, 92943, C9602, C9604, C9606, C9607). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check C9603 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C9603

2 active Local Coverage Determinations and 2 billing and coding articles list C9603. 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 C9603
ArticleTitleContractor(s)Related LCD
A56823Billing and Coding: Percutaneous Coronary InterventionWellpoint Federal—
A57479Billing and Coding: Percutaneous Coronary InterventionsWisconsin Physicians Service Insurance CorporationL34598, L34761

Denials to expect on C9603

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists C9603

CARC 151 · N362

units of C9603 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 C9603 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C9603 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 C9603

What does HCPCS code C9603 describe?

"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)" (short descriptor "Perc d-e cor stent ather br"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2013-01-01.

Is C9603 a CPT code?

No: CMS maintains C9603 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for C9603?

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C9603; its HCPCS pricing indicator is 53 (statute).

Is C9603 an add-on code?

C9603 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 8 primary codes such as 92933, 92937, 92941, 92943.

How many units of C9603 can be billed per day?

MUE limits for C9603: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data). For the practitioner MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover C9603?

Coverage code D (special coverage instructions apply). 2 active LCDs and 2 billing and coding articles list C9603 across 9 states: L33623 (Percutaneous Coronary Intervention), L34761 (Percutaneous Coronary Interventions), A56823, A57479.

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.