Key facts for C9604
- Medicare payment
- $11,794.23
- OPPS rate, SI J1
- Coverage code
- D
- special coverage instructions apply
- Facility outpatient MUE
- 2
- MAI 3
- NCCI PTP pairs
- 242
- 236 hospital outpatient
- LCDs and articles
- 2 / 2
TL;DR
HCPCS Level II C9604 reads "Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel" in the October 2026 file; it dates from 2013. Hospital outpatient departments are paid $11,794.23 for C9604 under status indicator J1, APC 5193 (Level 3 Endovascular Procedures), minimum unadjusted copayment $2,358.85 (October 2026 Addendum B). CMS caps C9604 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. C9604 is a primary code for 10 add-on codes (0914T, 92972, 92973, 92974). In the NCCI PTP files v323r0 C9604 appears in 11 practitioner pairs as column 2 and 231 as column 1 (most often with 0659T, 33500, 33501), and in 10 hospital outpatient pairs as column 2 and 226 as column 1. 2 active LCDs and 2 billing and coding articles list C9604 across 9 states: L33623 (Percutaneous Coronary Intervention), L34761 (Percutaneous Coronary Interventions), A56823, A57479. HCPCS record: BETOS P2F (major procedure, cardiovascular - other); pricing indicator 53; type of service 2 (surgery). 1 other active code opens with "Percutaneous transluminal revascularization of or through coronary artery bypass graft"; related codes: C9605, C9602, C9606, C9601.
C9604 descriptor and code status
The October 2026 HCPCS Level II file describes C9604 as “Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes.
| Field | Value |
|---|---|
| Short descriptor | Perc d-e cor revasc t cabg s |
| Added to HCPCS | 2013-01-01 |
| Last action | N (no maintenance), effective 2026-01-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 53: statute |
| BETOS category | P2F: major procedure, cardiovascular - other |
| Type of service | 2: surgery |
| Statute | 1833(t) |
Medicare payment for C9604
Hospital outpatient departments are paid $11,794.23 for C9604 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 $7,354.29 at a payment weight of 130.5758. The multiple-procedure discount applies when it is billed with another ASC procedure.
Medically Unlikely Edits for C9604
CMS caps C9604 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. The facility outpatient MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 2 | 3 Date of Service Edit: Clinical | Clinical: Data |
| Facility outpatient hospital | 2 | 3 Date of Service Edit: Clinical | Clinical: Data |
The MUE lookup for C9604 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, C9604 is the column-2 (bundled) code in 11 active pairs, 100% of which allow a modifier and the column-1 code in 231 (74% modifier-allowed); 30 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.
| Column-1 code | Pairs |
|---|---|
| 0659T (CPT; descriptor licensed by AMA) | 1 |
| 33500 (CPT; descriptor licensed by AMA) | 1 |
| 33501 (CPT; descriptor licensed by AMA) | 1 |
| 33502 (CPT; descriptor licensed by AMA) | 1 |
| 33503 (CPT; descriptor licensed by AMA) | 1 |
| 33504 (CPT; descriptor licensed by AMA) | 1 |
| 33505 (CPT; descriptor licensed by AMA) | 1 |
| 33506 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 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, C9604 is the column-2 (bundled) code in 10 active pairs, 100% of which allow a modifier and the column-1 code in 226 (100% modifier-allowed); 30 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.
| Column-1 code | Pairs |
|---|---|
| 0659T (CPT; descriptor licensed by AMA) | 1 |
| 33500 (CPT; descriptor licensed by AMA) | 1 |
| 33501 (CPT; descriptor licensed by AMA) | 1 |
| 33502 (CPT; descriptor licensed by AMA) | 1 |
| 33503 (CPT; descriptor licensed by AMA) | 1 |
| 33504 (CPT; descriptor licensed by AMA) | 1 |
| 33505 (CPT; descriptor licensed by AMA) | 1 |
| 33506 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 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 |
| 0903T (CPT; descriptor licensed by AMA) | 1 |
C9604 is a designated primary code for 10 add-on codes (0914T, 92972, 92973, 92974, 92978, 93571, C9601, C9603).
Pair counts show exposure, not the answer for one claim. Check C9604 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for C9604
2 active Local Coverage Determinations and 2 billing and coding articles list C9604. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
- Percutaneous Coronary Intervention, LCD L33623 · Wellpoint Federal
- Percutaneous Coronary Interventions (L34761) · Wisconsin Physicians Service Insurance Corporation
Denials to expect on C9604
the diagnosis or documentation does not meet the LCD or billing article that lists C9604
the modifier reported is inconsistent with the code
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for C9604 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C9604 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS C9604
What does HCPCS code C9604 describe?
"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel" (short descriptor "Perc d-e cor revasc t cabg s"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2013-01-01; last action N (no maintenance) effective 2026-01-01.
Is C9604 a CPT code?
It is not. C9604 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 C9604?
Hospital outpatient departments are paid $11,794.23 for C9604 under status indicator J1, APC 5193 (Level 3 Endovascular Procedures), minimum unadjusted copayment $2,358.85 (October 2026 Addendum B).
Is C9604 an add-on code?
C9604 is a primary code for 10 add-on codes (0914T, 92972, 92973, 92974).
How many units of C9604 can be billed per day?
CMS caps C9604 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the facility outpatient 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 C9604?
Coverage code D (special coverage instructions apply). 2 active LCDs and 2 billing and coding articles list C9604 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.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- ASC Addendum AA (covered surgical procedures), October 2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC AA.txtSHA-256 bc3479589b7b1f23…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
- NCCI Add-On Code edits, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file AOC_V2026Q4-F-MCR.xlsxSHA-256 eabb519623134549…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file lcd.csvSHA-256 9aee1bd7f14056b0…
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.