Summary & Overview
HCPCS Level II C9607: Percutaneous Revascularization for Coronary Chronic Total Occlusion
HCPCS Level II code C9607 represents a complex percutaneous coronary intervention for chronic total occlusion (CTO) using any combination of drug-eluting stent placement, atherectomy, and angioplasty in a single coronary vessel. This code captures high-acuity interventional cardiology procedures performed predominantly in hospital outpatient settings and is assigned to APC 0656 under the Medicare outpatient prospective payment system, reflecting resource-intensive care and specialized device use. Nationally, accurate coding of CTO interventions matters for clinical documentation, appropriate facility payment, and cross-payer consistency in coverage determinations. Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise overview of the clinical service represented by the code, typical site-of-service assignment, and the payer landscape addressed in the full publication. The report also outlines benchmarking context and policy considerations relevant to hospital outpatient reporting, coding relationships to common percutaneous coronary procedures, and clinical scenarios that commonly map to this service. Data not available in the input for specific service-line cost or utilization benchmarks is noted where applicable. This summary is intended to inform coding professionals, hospital billing teams, and policy analysts about the clinical and administrative implications of HCPCS Level II code C9607 at a national level.
Billing Code Overview
HCPCS Level II code C9607 describes percutaneous transluminal revascularization of a chronic total occlusion in a coronary artery, coronary artery branch, or coronary artery bypass graft, performed with any combination of drug-eluting intracoronary stent, atherectomy, and angioplasty for a single vessel.
Service Type: Interventional cardiology / Percutaneous coronary intervention (HCPCS Level II procedure)
Typical Site of Service: Hospital outpatient setting (assigned to APC 0656 for Medicare outpatient prospective payment system).
Clinical & Coding Specifications
Clinical Context
A 65-year-old patient with known coronary artery disease presents to the hospital outpatient interventional cardiology unit with symptoms consistent with unstable angina and imaging evidence of a chronic total occlusion in a major coronary artery branch. The care team schedules a percutaneous coronary intervention targeting a chronic total occlusion using a combination of drug-eluting intracoronary stent placement, atherectomy, and angioplasty on a single vessel. The procedure is performed by an Interventional Cardiology physician in the hospital outpatient setting, with catheter-based access, intravascular imaging and/or adjunctive devices as indicated, and post-procedure monitoring in the recovery area prior to discharge.
Coding Specifications
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HCPCS Level II code
C9607: Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel. Typical setting: hospital outpatient (APC 0656 for Medicare outpatient prospective payment system). -
Common Modifiers and when to use them:
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26— Professional Component -
Use when reporting the physician’s professional portion of a service separate from the technical component provided by the facility.
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51— Multiple Procedures -
Use when multiple distinct procedures are performed during the same session and Medicare or the payer requires reporting of a multiple procedure indicator for payment adjustments.