C9765 HCPCS - REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, LOWER EXTREMITY ARTERY(IES), EXCEPT TIBIAL/PERONEAL; WITH INTRAVASCULAR LITHOTRIPSY, AND TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL(S), WHEN PERFORMED

Code Information

HCPCS Code: C9765
Sequence Number: 0010
Short Description: Revasc intra lithotrip-stent
Long Description: Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed
Date Added: 7/1/2020
Action Code: N - No maintenance for this code
Action Effective Date: 7/1/2020
Classification: Temporary Hospital Outpatient Prospective Payment System
Coding System: HCPCS

Berenson-Eggers Type Of Service Code: P2F - Major procedure, cardiovascular-Other
Type Of Service Code:
- 2 - Surgery

Pricing Indicator Code:
- 53 - Statute
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
N/A
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: D - Special coverage instructions apply
ASC Payment Group Effective Date: 7/1/2020

Field Name	Field Value
Healthcare Common Procedure Coding System Code	C9765
HCPCS Sequence Number	0010
HCPCS Record Identification Code	3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description	Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed
HCPCS Short Description	Revasc intra lithotrip-stent
HCPCS Pricing Indicator Code 1	53 - Statute
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Statute Number	1833(t)
HCPCS Coverage Code	D - Special coverage instructions apply
HCPCS ASC Payment Group Code	YY
HCPCS ASC Payment Group Effective Date	7/1/2020
HCPCS Berenson-Eggers Type Of Service Code	P2F - Major procedure, cardiovascular-Other
HCPCS Type Of Service Code 1	2 - Surgery
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	7/1/2020
HCPCS Action Effective Date	7/1/2020
HCPCS Action Code	N - No maintenance for this code