Billing Code Overview

HCPCS Level II code C9607 describes percutaneous transluminal revascularization of a chronic total occlusion in a coronary artery, coronary artery branch, or coronary artery bypass graft, performed with any combination of drug-eluting intracoronary stent, atherectomy, and angioplasty for a single vessel.

Service Type: Interventional cardiology / Percutaneous coronary intervention (HCPCS Level II procedure)

Typical Site of Service: Hospital outpatient setting (assigned to APC 0656 for Medicare outpatient prospective payment system).

Clinical Context

A 65-year-old patient with known coronary artery disease presents to the hospital outpatient interventional cardiology unit with symptoms consistent with unstable angina and imaging evidence of a chronic total occlusion in a major coronary artery branch. The care team schedules a percutaneous coronary intervention targeting a chronic total occlusion using a combination of drug-eluting intracoronary stent placement, atherectomy, and angioplasty on a single vessel. The procedure is performed by an Interventional Cardiology physician in the hospital outpatient setting, with catheter-based access, intravascular imaging and/or adjunctive devices as indicated, and post-procedure monitoring in the recovery area prior to discharge.

Coding Specifications

• HCPCS Level II code C9607: Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel. Typical setting: hospital outpatient (APC 0656 for Medicare outpatient prospective payment system).

• Common Modifiers and when to use them:

• 26 — Professional Component

• Use when reporting the physician’s professional portion of a service separate from the technical component provided by the facility.

• 51 — Multiple Procedures

• Use when multiple distinct procedures are performed during the same session and Medicare or the payer requires reporting of a multiple procedure indicator for payment adjustments.

• 59 — Distinct Procedural Service

• Use when a procedure or service was distinct or independent from other services performed on the same day; indicates separate session, site, or procedure.

• LT — Left Side

• Use to indicate the left-sided procedure when laterality is required by the payer or documentation supports side-specific reporting.

• Associated Provider Taxonomies:

• Notes:

• The code is an HCPCS Level II code and should be reported as such: HCPCS Level II code C9607.

Related Diagnoses

• I25.10 — Atherosclerotic heart disease of native coronary artery without angina pectoris

  This diagnosis indicates chronic coronary atherosclerosis that can result in chronic total occlusion addressed by percutaneous revascularization.

• I25.110 — Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

  This indicates coronary atherosclerosis presenting with unstable angina, which may necessitate urgent percutaneous intervention including stent placement and angioplasty.

• I25.119 — Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

  This denotes atherosclerotic coronary disease with angina not otherwise specified and is clinically relevant as an indication for revascularization.

• I20.0 — Unstable angina

  Unstable angina is an acute coronary syndrome that can prompt percutaneous coronary intervention for revascularization of occluded vessels.

• I21.9 — Acute myocardial infarction, unspecified

  Acute myocardial infarction is an indication for emergent or urgent coronary revascularization procedures, including percutaneous approaches when appropriate.

Related Codes

• 92928 is a commonly used stent placement/angioplasty code and may be reported for single-vessel stent placement; it is related to HCPCS Level II code C9607 when stent placement and angioplasty are components of the revascularization, depending on payer policy for reporting HCPCS versus CPT procedures.

• 92973 is used for percutaneous coronary thrombectomy and may be performed in the same session if thrombus removal is required before stent placement or angioplasty.

• 93458 is used for catheter placement for coronary angiography and typically precedes therapeutic interventions such as those described by HCPCS Level II code C9607.

• 93571 is an intravascular assessment code often used adjunctively to measure flow reserve or pressure during PCI procedures; it may be used in the same procedural episode for physiologic assessment.

• Codes commonly used together: 93458 (diagnostic catheter placement) often precedes therapeutic codes such as 92928 or HCPCS Level II code C9607. 93571 may be used adjunctively. 92973 may be used when thrombectomy is required prior to definitive revascularization.

National mean rates vary notably: Medicare mean is $0.00 while BUCA (average commercial) mean is $2,139.29, indicating commercial mean allowed rates are higher than Medicare in the provided input. The table and chart below present the full breakdown by payer.

Rate dispersion (P75 − P25) is widest for UnitedHealthcare at $11,768.00 and large for Blue Cross Blue Shield at $10,235.00, indicating substantial variability. The tightest distributions are for Cigna Health (range $10.00) and Aetna (range $234.00). The table and chart below present the full breakdown by payer.