What is a C-code?
According to the Centers for Medicare and Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) or “C-codes” are unique temporary pricing codes established for the Prospective Payment System and are only valid for Medicare on claims for hospital outpatient department services and procedures.
How does the HIFU C-code work?
In May 2017 CMS accepted SonaCare Medical’s application for a C-code for HIFU, which became effective on July 1, 2017.
This HCPCS code C9747, under the ambulatory payment classification (APC) 5376, is specific to the ablation of prostate tissue using transrectally delivered high intensity focused ultrasound (HIFU), including image guidance.
This C-code is applicable to procedures performed in hospitals and ambulatory surgery centers under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and may also be applied to claims from other providers in the future.
How does this C-code help HIFU prostate patients?
The establishment of a C-code makes HIFU a more realistic option, financially, for men seeking a minimally-invasive prostate procedure. Previously, a HIFU prostate ablation was not eligible for any reimbursement, requiring all patients to pay out-of-pocket for the procedure. With the new C-code, Medicare patients can now apply for partial reimbursement, which may reduce the total cost of the procedure by thousands of dollars.
The C-code should help streamline billing, reducing delays in reimbursement for Sonablate® patients, and may open the door to broader coverage by private and commercial payers in the future.