C2628 Catheter Occlusion HCPCS: Reimbursement & Policy

HCPCS Level II code C2628 denotes a catheter intended for occlusion, used in procedures to block or occlude vessels or lumens. This code identifies a discrete medical device supplied for use in interventional procedures and matters nationally because device coding affects billing accuracy, device tracking, and coverage determinations across payer systems. Accurate coding supports claims processing and influences device utilization reporting.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical context for catheter occlusion devices, common sites of service where these devices are used, and the implications for billing and coverage workflows. The publication outlines typical benchmarks related to coding and reimbursement, common modifier usage, and payer-specific considerations for device claims where available.

The report is intended for billing managers, clinical supply chain staff, and policy analysts seeking a concise reference on coding and administrative considerations for catheter occlusion devices. It also summarizes areas where data was not provided and directs readers to look for payer policy updates and device-specific documentation for coverage rules and payment rates.

Billing Code Overview

HCPCS Level II code C2628 represents a catheter designed for occlusion. The service type is catheter-related medical supply or device used to achieve vascular or luminal occlusion. The typical site of service for procedures involving this device is inpatient or outpatient hospital settings, ambulatory surgical centers, and interventional radiology suites, where catheter-based occlusion procedures are performed.

Data not available in the input.

Clinical Context

A typical patient scenario involves an adult hospitalized for symptomatic central venous catheter (CVC) occlusion or a peripherally inserted central catheter (PICC) that is non-functional due to thrombotic or mechanical blockage. The patient may present with inability to infuse medications, inability to withdraw blood, or alarms from infusion pumps. The clinical workflow begins with bedside assessment by the nursing team and an advanced practice provider or physician confirming catheter occlusion after troubleshooting (flushing attempts, catheter repositioning, aspiration attempts). Imaging (ultrasound or chest x-ray) may be obtained to evaluate catheter position and thrombus if indicated. If the catheter is irreversibly occluded or cannot be salvaged, interventional radiology or the surgical team performs catheter removal and replacement as indicated. The procedure may occur in an outpatient infusion center, hospital inpatient unit, interventional radiology suite, or operating room depending on complexity and patient condition. Documentation should include indication for removal, attempts at conservative management, catheter type and location, device description C2628 (catheter, occlusion), personnel involved, anesthesia or sedation provided, and post-procedure disposition and complications.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or technical effort substantially exceeds typical expectations for catheter removal or complex salvage.

Taxonomy Code	Specialty	Notes
`364S00000X`	Vascular Surgery	Frequently performs central venous catheter placement, salvage, and removal.
`207L00000X`	Interventional Radiology	Performs image-guided catheter removals, thrombolysis, and replacements.
`363A00000X`	Critical Care Medicine	Manages acute bedside catheter complications in critically ill patients.
`163W00000X`	Emergency Medicine	Manages acute catheter occlusions in the ED and coordinates removal or replacement.
`363LP0808X`	Hospitalist	Coordinates inpatient management, conservative measures, and disposition related to catheter occlusion.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Occluded vascular catheters can be associated with device-related infection requiring removal.
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of right lower extremity	Catheter-related thrombosis can cause venous thrombosis presenting with catheter occlusion.
`I80.2`	Phlebitis and thrombophlebitis of other deep vessels of lower extremities	Thrombophlebitis associated with central venous access may contribute to catheter dysfunction.
`R66.2`	Wheeze	Data not directly related — Data not available in the input.
`Z45.2`	Encounter for adjustment and management of vascular device, such as a central venous catheter	Used for encounters focused on management, maintenance, or troubleshooting of central venous devices leading to occlusion management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36580`	Insertion of tunneled centrally inserted central venous catheter, with subcutaneous port or pump, complete procedure	May be performed when an occluded catheter is removed and a new tunneled catheter with port is placed in the same or subsequent encounter.
`36568`	Replacement, complete, of tunneled central venous catheter, without subcutaneous port or pump, requiring only local anesthesia	Used when an occluded tunneled catheter is removed and a replacement catheter is placed during the same session.
`36561`	Replacement, open, of central venous catheter, by separate skin incision or same incision	Applicable when open surgical replacement of an occluded catheter is required.
`36589`	Insertion of intra-vascular introducer, for central venous access, without catheter placement (e.g., peel-away introducer)	May be used as part of the workflow when introducer placement is needed prior to replacement of an occluded catheter.
`36200`	Introduction of catheter, aorta, non-selective, diagnostic, with or without injection	Used when diagnostic venography is performed to evaluate central venous patency in the setting of catheter occlusion.
`92980`	Percutaneous transcatheter placement of intracoronary stent(s), with or without transluminal angioplasty	Data not applicable to central venous catheters — Data not available in the input.

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Summary & Overview

HCPCS C2628: Catheter, Occlusion