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HCPCS C9605 · Level II · C code

C9605: Perc d-e cor revasc t cabg b, 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 C9605

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
204
198 hospital outpatient
LCDs and articles
2 / 2
add-on code

TL;DR

CMS describes HCPCS C9605, added in 2013, 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; each additional branch subtended by the bypass graft (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 C9605; its HCPCS pricing indicator is 53 (statute). Its 2026 Q4 MUEs per date of service: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data). C9605 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 2 primary codes such as 92937, C9604. In the NCCI PTP files v323r0 C9605 appears in 0 practitioner pairs as column 2 and 204 as column 1, and in 0 hospital outpatient pairs as column 2 and 198 as column 1. 2 active LCDs and 2 billing and coding articles list C9605 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 revascularization of or through coronary artery bypass graft"; related codes: C9604, C9606, C9607, C9602.

C9605 descriptor and code status

The October 2026 HCPCS Level II file describes C9605 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; each additional branch subtended by the bypass graft (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 C9605
FieldValue
Short descriptorPerc d-e cor revasc t cabg b
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 C9605

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C9605; 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 C9605

Its 2026 Q4 MUEs per date of service: 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 C9605 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 C9605 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, C9605 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 204 (75% modifier-allowed); 27 earlier pairs have been deleted.

Column-2 codes bundled into C9605 (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, C9605 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 198 (100% modifier-allowed); 27 earlier pairs have been deleted.

Column-2 codes bundled into C9605 (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

C9605 is an add-on code: it is payable only with a primary service on the same claim (92937, C9604). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check C9605 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C9605

2 active Local Coverage Determinations and 2 billing and coding articles list C9605. 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 C9605
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 C9605

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists C9605

CARC 151 · N362

units of C9605 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 C9605 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C9605 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 C9605

What does HCPCS code C9605 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; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)" (short descriptor "Perc d-e cor revasc t cabg b"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2013-01-01.

Is C9605 a CPT code?

No. C9605 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for C9605?

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for C9605; its HCPCS pricing indicator is 53 (statute).

Is C9605 an add-on code?

C9605 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 2 primary codes such as 92937, C9604.

How many units of C9605 can be billed per day?

Its 2026 Q4 MUEs per date of service: 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 C9605?

Coverage code D (special coverage instructions apply). 2 active LCDs and 2 billing and coding articles list C9605 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.