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HCPCS C9781 · Level II · C code

C9781: Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), 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 C9781

Medicare payment
$13,116.76
OPPS rate, SI J1
Coverage code
D
special coverage instructions apply
Facility outpatient MUE
1
MAI 3
OPPS status
SI J1
Hospital Part B services paid through a comprehensive APC
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS C9781, added in 2022, as "Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed". Hospital outpatient departments are paid $13,116.76 for C9781 under status indicator J1, APC 5115 (Level 5 Musculoskeletal Procedures), minimum unadjusted copayment $2,623.36 (October 2026 Addendum B). CMS caps C9781 at practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. No current LCD or billing article lists C9781; its HCPCS coverage code is D (special coverage instructions apply). HCPCS record: BETOS P8A (endoscopy - arthroscopy); pricing indicator 53; type of service 9 (other medical items or services). Nearby codes: C9779, C9777, C9785, C9789.

C9781 descriptor and code status

The October 2026 HCPCS Level II file describes C9781 as “Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes.

HCPCS file attributes of C9781
FieldValue
Short descriptorArthro/shoul surg; w/spacer
Added to HCPCS2022-04-01
Last actionN (no maintenance), effective 2022-04-01
Coverage codeD: special coverage instructions apply
Pricing indicator53: statute
BETOS categoryP8A: endoscopy - arthroscopy
Type of service9: other medical items or services
Statute1833(t)

Medicare payment for C9781

Hospital outpatient departments are paid $13,116.76 for C9781 under status indicator J1, APC 5115 (Level 5 Musculoskeletal Procedures), minimum unadjusted copayment $2,623.36 (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 5115 (Level 5 Musculoskeletal Procedures), national unadjusted payment $13,116.76 with a minimum unadjusted copayment of $2,623.36.

Ambulatory surgical center (Addendum AA)

Payment indicator J8 (Device-intensive procedure; paid at adjusted rate), national rate $10,217.78 at a payment weight of 181.4172. The multiple-procedure discount applies when it is billed with another ASC procedure.

Medically Unlikely Edits for C9781

CMS caps C9781 at practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure) 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.

MUE values for C9781 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalNature of Service/Procedure
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for C9781 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists C9781 in v323r0.

C9781 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 C9781 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C9781

No current LCD or billing and coding article lists C9781. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on C9781

CARC 50 · N115

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

CARC 151 · N362

units of C9781 exceed the facility outpatient MUE of 1 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 C9781 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C9781 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 C9781

What does HCPCS code C9781 describe?

"Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed" (short descriptor "Arthro/shoul surg; w/spacer"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2022-04-01.

Is C9781 a CPT code?

It is not. C9781 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 C9781?

Hospital outpatient departments are paid $13,116.76 for C9781 under status indicator J1, APC 5115 (Level 5 Musculoskeletal Procedures), minimum unadjusted copayment $2,623.36 (October 2026 Addendum B).

How many units of C9781 can be billed per day?

CMS caps C9781 at practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. For the facility outpatient MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover C9781?

No current LCD or billing article lists C9781; 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.