Summary & Overview
HCPCS C1726: Catheter, Balloon Dilatation, Non-Vascular
HCPCS Level II code C1726 denotes a non-vascular balloon dilatation catheter used to widen narrowed non-vascular lumens. Nationally, this device-level code matters because it identifies a distinct supply that may be billed alongside procedural services for endoluminal dilatation outside the vascular system. Accurate coding affects device tracking, payer adjudication, and reporting of resource use for procedures in surgical and outpatient settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for non-vascular balloon dilatation, the typical sites of service, and what to expect in payer coverage patterns. The publication presents benchmarks for device-level payments where available, notes common billing practices, and summarizes relevant policy considerations that influence claim processing and reimbursement.
The content is intended to help billing managers, revenue cycle staff, and clinicians understand how HCPCS Level II code C1726 is used in practice, what payers commonly evaluate when adjudicating claims for device supplies, and where to look for further payer-specific guidance. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C1726 describes a catheter intended for balloon dilatation in non-vascular procedures. The service type is balloon dilatation catheter placement, a device used to widen strictured or narrowed non-vascular lumens or passages.
Typical sites of service include ambulatory surgical centers, hospital outpatient departments, and operating rooms where non-vascular balloon dilatation procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with progressive urethral stricture disease presents with urinary hesitancy, weak stream, and recurrent urinary tract infections. After evaluation including uroflowmetry and cystoscopy confirming a short segment non-vascular luminal narrowing, the urology team plans an in-office or ambulatory surgical center procedure for mechanical balloon dilation using a non-vascular balloon dilatation catheter. The workflow: pre-procedure evaluation (history, consent, anesthesia assessment), topical or local anesthesia with or without moderate sedation, cystoscopic guidance to position the balloon across the stricture, incremental balloon inflation to graded diameters per device instructions, deflation and removal, post-dilation cystoscopic inspection and possible indwelling catheter placement for short-term drainage. Observation for immediate complications (bleeding, urinary retention, infection) follows before discharge with follow-up arranged for symptom assessment and potential repeat intervention if recurrence occurs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier - standard reporting | Use when no specific modifier applies and procedure is billed as usual |
22 | Increased procedural services |