Medicare Hospital Outpatient Category Codes
(C-codes) for Medical Devices
Last updated: July 2007
C-Code Background
As of January 1, 2005, the Centers for Medicare and Medicaid Services (CMS) requires hospitals to report all device-related category codes (C-codes) on Medicare claims when medical devices are used in conjunction with the procedure(s) billed in the outpatient setting.1
Effective for services performed on or after April 1, 2005, Medicare's Outpatient Code Editor includes edits to ensure that certain "device-required" procedure codes are accompanied by at least one associated device C-code. If appropriate C-codes are not identified on a submitted Medicare claim, the claim will be returned to the hospital for correction.2
In Our PDF Documents
Our PDF documents (top of page) contain lists of all C-codes that pertain to Boston Scientific products. As always, correct coding should be verified with your Medicare fiscal intermediary and private payers. A complete list of C-codes can be found on the CMS website, under 2006 Alpha-Numeric HCPCS File.
Please contact a reimbursement specialist by clicking the link below if you have questions regarding reimbursement for Boston Scientific technologies used in the outpatient setting.
- Centers for Medicare and Medicaid Services. Medicare Claims Processing. Effective January 1, 2005 (unless otherwise specified, the effective date is the date of service). CMS Manual System, change request 3583: Transmittal 387; CMS Pub. 100-04. December 3, 2004. Available at: http://www.cms.hhs.gov/transmittals/downloads/R387CP.pdf. Accessed March 2007.
- Centers for Medicare and Medicaid Services. January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Billing for Devices that Do Not Have Transitional Pass-Through Status and that Are Not Classified as New Technology Ambulatory Payment Classification (APCs) Groups. Medlearn Matters (MM3606). December 23, 2004. Available at: http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3606.pdf. Accessed March 2007.
C5-184-0307
Disclaimer: The information provided on this website was obtained from third-party sources and is subject to change without notice, as a result of changes in reimbursement laws, regulations, rules and policies. All content on this website is informational only, general in nature and does not cover all situations or all payers’ rules and policies. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that Boston Scientific assumes will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing and payment levels for healthcare procedures.
This website represents no promise or guarantee by Boston Scientific regarding coverage, coding, billing and payment levels. Boston Scientific specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information on this website.
