C9781 HCPCS - ARTHROSCOPY, SHOULDER, SURGICAL; WITH IMPLANTATION OF SUBACROMIAL SPACER (E.G., BALLOON), INCLUDES DEBRIDEMENT (E.G., LIMITED OR EXTENSIVE), SUBACROMIAL DECOMPRESSION, ACROMIOPLASTY, AND BICEPS TENODESIS WHEN PERFORMED

Code Information

HCPCS Code: C9781
Sequence Number: 0010
Short Description: Arthro/shoul surg; w/spacer
Long Description: Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed
Date Added: 4/1/2022
Action Code: N - No maintenance for this code
Action Effective Date: 4/1/2022
Classification: Temporary Hospital Outpatient Prospective Payment System
Coding System: HCPCS

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: 4/1/2022

Field Name	Field Value
Healthcare Common Procedure Coding System Code	C9781
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	Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed
HCPCS Short Description	Arthro/shoul surg; w/spacer
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	4/1/2022
HCPCS Berenson-Eggers Type Of Service Code	P8A - Endoscopy - arthroscopy
HCPCS Type Of Service Code 1	9 - Other medical items or services
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	4/1/2022
HCPCS Action Effective Date	4/1/2022
HCPCS Action Code	N - No maintenance for this code