Key facts for C9901
- Medicare payment
- $10,860.07
- OPPS rate, SI J1
- Coverage code
- D
- special coverage instructions apply
- Facility outpatient MUE
- 1
- MAI 2
- NCCI PTP pairs
- 295
- 289 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
C9901 is a Level II code from the C section (hospital outpatient prospective payment system, temporary codes), in use since 2024: "Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components". Hospital outpatient departments are paid $10,860.07 for C9901 under status indicator J1, APC 5362 (Level 2 Laparoscopy and Related Services), minimum unadjusted copayment $2,172.02 (October 2026 Addendum B). MUE limits for C9901: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). In the NCCI PTP files v323r0 C9901 appears in 19 practitioner pairs as column 2 and 276 as column 1 (most often with 43610, 43611, 43620), and in 19 hospital outpatient pairs as column 2 and 270 as column 1. No current LCD or billing article lists C9901; 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: C9797, C9789, C9785, C9781.
C9901 descriptor and code status
The October 2026 HCPCS Level II file describes C9901 as “Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with 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.
| Field | Value |
|---|---|
| Short descriptor | Endo defect closure gi tract |
| Added to HCPCS | 2024-07-01 |
| Last action | N (no maintenance), effective 2026-01-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 53: statute |
| BETOS category | P1G: major procedure - other |
| Type of service | 2: surgery |
| Statute | 1033(t) |
Medicare payment for C9901
Hospital outpatient departments are paid $10,860.07 for C9901 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 J8 (Device-intensive procedure; paid at adjusted rate), national rate $6,759.42 at a payment weight of 120.0138. The multiple-procedure discount applies when it is billed with another ASC procedure.
Medically Unlikely Edits for C9901
MUE limits for C9901: 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.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
The MUE lookup for C9901 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, C9901 is the column-2 (bundled) code in 19 active pairs, 100% of which allow a modifier and the column-1 code in 276 (92% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.
| Column-1 code | Pairs |
|---|---|
| 43610 (CPT; descriptor licensed by AMA) | 1 |
| 43611 (CPT; descriptor licensed by AMA) | 1 |
| 43620 (CPT; descriptor licensed by AMA) | 1 |
| 43621 (CPT; descriptor licensed by AMA) | 1 |
| 43622 (CPT; descriptor licensed by AMA) | 1 |
| 43631 (CPT; descriptor licensed by AMA) | 1 |
| 43632 (CPT; descriptor licensed by AMA) | 1 |
| 43633 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 00520 (CPT; descriptor licensed by AMA) | 1 |
| 00731 (CPT; descriptor licensed by AMA) | 1 |
| 00732 (CPT; descriptor licensed by AMA) | 1 |
| 00811 (CPT; descriptor licensed by AMA) | 1 |
| 00812 (CPT; descriptor licensed by AMA) | 1 |
| 00813 (CPT; descriptor licensed by AMA) | 1 |
| 0213T (CPT; descriptor licensed by AMA) | 1 |
| 0216T (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, C9901 is the column-2 (bundled) code in 19 active pairs, 100% of which allow a modifier and the column-1 code in 270 (87% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.
| Column-1 code | Pairs |
|---|---|
| 43610 (CPT; descriptor licensed by AMA) | 1 |
| 43611 (CPT; descriptor licensed by AMA) | 1 |
| 43620 (CPT; descriptor licensed by AMA) | 1 |
| 43621 (CPT; descriptor licensed by AMA) | 1 |
| 43622 (CPT; descriptor licensed by AMA) | 1 |
| 43631 (CPT; descriptor licensed by AMA) | 1 |
| 43632 (CPT; descriptor licensed by AMA) | 1 |
| 43633 (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 |
| 0652T (CPT; descriptor licensed by AMA) | 1 |
| 0653T (CPT; descriptor licensed by AMA) | 1 |
| 0708T (CPT; descriptor licensed by AMA) | 1 |
| 10005 (CPT; descriptor licensed by AMA) | 1 |
C9901 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 C9901 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for C9901
No current LCD or billing and coding article lists C9901. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.
Denials to expect on C9901
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 C9901 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for C9901 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 C9901
What does HCPCS code C9901 describe?
"Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components" (short descriptor "Endo defect closure gi tract"), in the C section (hospital outpatient prospective payment system, temporary codes). Added 2024-07-01; last action N (no maintenance) effective 2026-01-01.
Is C9901 a CPT code?
No: CMS maintains C9901 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.
What does Medicare pay for C9901?
Hospital outpatient departments are paid $10,860.07 for C9901 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 C9901 can be billed per day?
MUE limits for C9901: 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 C9901?
No current LCD or billing article lists C9901; 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.