Key facts for C9761
- Medicare payment
- $9,671.50
- OPPS rate, SI J1
- Coverage code
- D
- special coverage instructions apply
- Facility outpatient MUE
- 2
- MAI 2
- NCCI PTP pairs
- 274
- 217 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
HCPCS Level II C9761 reads "Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if necessary, with use of steerable ureteral catheter or suction-integrated ureteroscope" in the October 2026 file; it dates from 2020. Hospital outpatient departments are paid $9,671.50 for C9761 under status indicator J1, APC 5376 (Level 6 Urology and Related Services), minimum unadjusted copayment $1,934.30 (October 2026 Addendum B). Its 2026 Q4 MUEs per date of service: practitioner 2 (MAI 2, Anatomic Consideration); hospital outpatient 2 (MAI 2, Anatomic Consideration). In the NCCI PTP files v323r0 C9761 appears in 5 practitioner pairs as column 2 and 269 as column 1 (most often with 50080, 50081, 50561), and in 5 hospital outpatient pairs as column 2 and 212 as column 1. No current LCD or billing article lists C9761; its HCPCS coverage code is D (special coverage instructions apply). HCPCS record: BETOS P5E (ambulatory procedures - other); pricing indicator 53; type of service 2 (surgery), F (ambulatory surgical center). 4 other active codes open with "Cystourethroscopy"; related codes: C9740, C9739, C8014, C7550.
C9761 descriptor and code status
The October 2026 HCPCS Level II file describes C9761 as “Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if necessary, with use of steerable ureteral catheter or suction-integrated ureteroscope”. 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 "C9761 CPT code", C9761 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.
| Field | Value |
|---|---|
| Short descriptor | Cysto, litho, vacuum kidney |
| Added to HCPCS | 2020-10-01 |
| Last action | N (no maintenance), effective 2026-07-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 53: statute |
| BETOS category | P5E: ambulatory procedures - other |
| Type of service | 2: surgery; F: ambulatory surgical center |
| Statute | 1833(t) |
Medicare payment for C9761
Hospital outpatient departments are paid $9,671.50 for C9761 under status indicator J1, APC 5376 (Level 6 Urology and Related Services), minimum unadjusted copayment $1,934.30 (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 5376 (Level 6 Urology and Related Services), national unadjusted payment $9,671.50 with a minimum unadjusted copayment of $1,934.30.
Ambulatory surgical center (Addendum AA)
Payment indicator J8 (Device-intensive procedure; paid at adjusted rate), national rate $6,612.45 at a payment weight of 117.4044. The multiple-procedure discount applies when it is billed with another ASC procedure.
Medically Unlikely Edits for C9761
Its 2026 Q4 MUEs per date of service: practitioner 2 (MAI 2, Anatomic Consideration); hospital outpatient 2 (MAI 2, Anatomic Consideration). The facility outpatient MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 2 | 2 Date of Service Edit: Policy | Anatomic Consideration |
| Facility outpatient hospital | 2 | 2 Date of Service Edit: Policy | Anatomic Consideration |
The MUE lookup for C9761 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, C9761 is the column-2 (bundled) code in 5 active pairs, 100% of which allow a modifier and the column-1 code in 269 (65% modifier-allowed); 10 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: HCPCS/CPT procedure code definition.
| Column-1 code | Pairs |
|---|---|
| 50080 (CPT; descriptor licensed by AMA) | 1 |
| 50081 (CPT; descriptor licensed by AMA) | 1 |
| 50561 (CPT; descriptor licensed by AMA) | 1 |
| 50590 (CPT; descriptor licensed by AMA) | 1 |
| 52356 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 00910 (CPT; descriptor licensed by AMA) | 1 |
| 00916 (CPT; descriptor licensed by AMA) | 1 |
| 00918 (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 |
| 0708T (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, C9761 is the column-2 (bundled) code in 5 active pairs, 100% of which allow a modifier and the column-1 code in 212 (87% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: HCPCS/CPT procedure code definition.
| Column-1 code | Pairs |
|---|---|
| 50080 (CPT; descriptor licensed by AMA) | 1 |
| 50081 (CPT; descriptor licensed by AMA) | 1 |
| 50561 (CPT; descriptor licensed by AMA) | 1 |
| 50590 (CPT; descriptor licensed by AMA) | 1 |
| 52356 (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 |
| 0708T (CPT; descriptor licensed by AMA) | 1 |
| 0709T (CPT; descriptor licensed by AMA) | 1 |
| 0903T (CPT; descriptor licensed by AMA) | 1 |
| 0904T (CPT; descriptor licensed by AMA) | 1 |
C9761 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 C9761 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for C9761
No current LCD or billing and coding article lists C9761. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.
Denials to expect on C9761
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 C9761 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C9761 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 C9761
What does HCPCS code C9761 describe?
"Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if necessary, with use of steerable ureteral catheter or suction-integrated ureteroscope" (short descriptor "Cysto, litho, vacuum kidney"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2020-10-01; last action N (no maintenance) effective 2026-07-01.
Is C9761 a CPT code?
No. C9761 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "C9761 CPT code" mean this Level II code.
What does Medicare pay for C9761?
Hospital outpatient departments are paid $9,671.50 for C9761 under status indicator J1, APC 5376 (Level 6 Urology and Related Services), minimum unadjusted copayment $1,934.30 (October 2026 Addendum B).
How many units of C9761 can be billed per day?
Its 2026 Q4 MUEs per date of service: practitioner 2 (MAI 2, Anatomic Consideration); hospital outpatient 2 (MAI 2, Anatomic Consideration). For the facility outpatient MUE (MAI 2), units above 2 deny for the whole day as a policy limit; denials arrive as CARC 151.
Does Medicare cover C9761?
No current LCD or billing article lists C9761; 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.
- 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…
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.