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HCPCS C9785 · Level II · C code

C9785: Endoscopic outlet reduction, gastric pouch application, 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 C9785

Medicare payment
$10,860.07
OPPS rate, SI J1
Coverage code
D
special coverage instructions apply
Facility outpatient MUE
1
MAI 2
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

C9785 is a Level II code from the C section (hospital outpatient prospective payment system, temporary codes), in use since 2023: "Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components". Hospital outpatient departments are paid $10,860.07 for C9785 under status indicator J1, APC 5362 (Level 2 Laparoscopy and Related Services), minimum unadjusted copayment $2,172.02 (October 2026 Addendum B). Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). No current LCD or billing article lists C9785; its HCPCS coverage code is D (special coverage instructions apply). HCPCS record: BETOS P1G (major procedure - other); pricing indicator 53; type of service 2 (surgery). Nearby codes: C9781, C9789, C9779, C9777.

C9785 descriptor and code status

The October 2026 HCPCS Level II file describes C9785 as “Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components”. It sits in the C section (hospital outpatient prospective payment system, temporary codes), listed with the other C codes.

HCPCS file attributes of C9785
FieldValue
Short descriptorEndo outlet restrict w/tube
Added to HCPCS2023-07-01
Last actionN (no maintenance), effective 2026-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator53: statute
BETOS categoryP1G: major procedure - other
Type of service2: surgery
Statute1833(t)

Medicare payment for C9785

Hospital outpatient departments are paid $10,860.07 for C9785 under status indicator J1, APC 5362 (Level 2 Laparoscopy and Related Services), minimum unadjusted copayment $2,172.02 (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 5362 (Level 2 Laparoscopy and Related Services), national unadjusted payment $10,860.07 with a minimum unadjusted copayment of $2,172.02.

Ambulatory surgical center (Addendum AA)

Payment indicator G2 (Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight), national rate $5,120.50 at a payment weight of 90.9148. The multiple-procedure discount applies when it is billed with another ASC procedure.

Medically Unlikely Edits for C9785

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). 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.

MUE values for C9785 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for C9785 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists C9785 in v323r0.

C9785 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 C9785 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for C9785

No current LCD or billing and coding article lists C9785. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on C9785

CARC 50 · N115

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

CARC 151 · N362

units of C9785 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 C9785 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C9785 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 C9785

What does HCPCS code C9785 describe?

"Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components" (short descriptor "Endo outlet restrict w/tube"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2023-07-01; last action N (no maintenance) effective 2026-01-01.

Is C9785 a CPT code?

No. C9785 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for C9785?

Hospital outpatient departments are paid $10,860.07 for C9785 under status indicator J1, APC 5362 (Level 2 Laparoscopy and Related Services), minimum unadjusted copayment $2,172.02 (October 2026 Addendum B).

How many units of C9785 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the facility outpatient MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover C9785?

No current LCD or billing article lists C9785; 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.