Summary & Overview
HCPCS C9604: Single-Vessel Graft Percutaneous Revascularization
HCPCS Level II code C9604 designates a complex revascularization procedure performed through a coronary artery bypass graft using any combination of drug‑eluting stent placement, atherectomy and angioplasty, with distal protection when performed for a single vessel. The code captures a high-acuity interventional cardiology service often performed in inpatient hospital settings and is relevant to case mix, billing specificity, and resource allocation in cardiac care nationally.
Major national payers in scope for this code include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Stakeholders can expect coverage considerations to hinge on documentation of graft access, procedural components (stent, atherectomy, angioplasty), and clinical indications tied to ischemic events.
Readers will find concise benchmarks and practical context: a clinical summary of the procedure captured by C9604, payer landscape and common billing modifiers, and coding relationships to catheter-based coronary procedures. The publication highlights coding specificity needed for single-vessel graft revascularization versus native vessel interventions and clarifies where related revascularization CPT/HCPCS procedure codes align or differ. If additional claim- or payer-specific pricing, utilization, or policy details are required, those elements are not provided in the input.
Billing Code Overview
HCPCS Level II code C9604 describes percutaneous transluminal revascularization of or through a coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug‑eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel. This service falls under Cardiology / Interventional Cardiology and is typically provided in an Inpatient Hospital (POS 21) setting. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with prior coronary artery bypass grafting (including an internal mammary artery graft) presents to the inpatient hospital for new-onset chest pain and elevated cardiac biomarkers. Coronary angiography demonstrates significant stenosis of a single bypass graft supplying the left anterior descending territory. The interventional cardiology team performs percutaneous transluminal revascularization of or through the coronary artery bypass graft using angioplasty and deployment of a drug-eluting intracoronary stent; distal protection is used during the procedure. The service is performed in the inpatient hospital (POS 21) by an interventional cardiologist, with documentation of the graft treated, devices used (drug-eluting stent, atherectomy if performed), and any distal protection device.
Coding Specifications
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HCPCS Level II code
C9604: Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug‑eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel. -
Common Modifiers
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59- Distinct Procedural Service- Use when the revascularization procedure is distinct or separate from another service performed at the same session and documentation supports separate procedural service.
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51- Multiple Procedures- Use when multiple procedures are performed during the same operative session and payer guidance requires reporting a multiple-procedure modifier for secondary procedures.
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Associated Provider Taxonomies
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207RC0000X- Cardiovascular Disease Physician- Specialty representing physicians trained in general cardiology and cardiovascular disease management.
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207RI0011X- Interventional Cardiology Physician- Specialty representing physicians trained in percutaneous coronary and structural heart interventions.
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207RG0300X- Geriatric Medicine Physician- Specialty representing physicians focused on medical care of older adults.
Related Diagnoses
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I21.9-- Data not available in the input.
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I21.A1-- Data not available in the input.
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I21.A9-- Data not available in the input.
Related Codes
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92928- Data not available in the input. -
92933- Data not available in the input. -
92929- Data not available in the input. -
92934- Data not available in the input. -
92937- Data not available in the input. -
92938- Data not available in the input. -
92941- Data not available in the input. -
92943- Data not available in the input. -
92944- Data not available in the input.
National Reimbursement Benchmarks
National mean rates for HCPCS Level II code C9604 show that Medicare's benchmark is lower than the BUCA (average commercial) mean: BUCA averages $5,745.34 nationally while Medicare data is not available in the input. Among commercial payers, Aetna and UnitedHealthcare report substantially higher mean rates ($12,807.07 and $11,836.32 respectively) compared with BUCA, Blue Cross Blue Shield, and Cigna Health.
Rate dispersion (P75 minus P25) varies widely: Blue Cross Blue Shield shows a large spread ($6,499.50), UnitedHealthcare and Aetna show substantial dispersion ($11,543.00 and $9,877.00 respectively when comparing their P75 and P25), while Cigna Health is the tightest with only a $10.00 spread between P25 and P75. The table and chart below present the full breakdown.
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