HCPCS Level II C9607: Percutaneous Revascularization of Coronary CTO, Single Vessel
Commercial payers pay $14892 on average nationally for this procedure.
HCPCS Level II code C9607 describes percutaneous transluminal revascularization of a chronic total occlusion in a coronary artery, branch, or coronary artery bypass graft using a combination of drug-eluting intracoronary stent, atherectomy, and angioplasty for a single vessel; service type: complex percutaneous coronary intervention (PCI) for chronic total occlusion; typical site of service: inpatient or outpatient catheterization laboratory or hybrid operating room where interventional cardiology procedures are performed.
For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.
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National Reimbursement Benchmarks
Commercial reimbursement for HCPCS C9607 centers around BUCA’s average commercial benchmark of $14,892, with payer-specific means spanning from Aetna’s modest $786 to Blue Cross Blue Shield’s much higher $19,989.6, Cigna at $15,975.7, and UnitedHealth Group at $12,621.6. Blue Cross Blue Shield and Cigna exhibit higher central tendency, while Aetna’s mean sits far lower than the BUCA average, indicating a split market where BUCA aligns closer to mid-to-high commercial payers rather than the low end.
Dispersion (P75 minus P25) highlights variation in contract consistency: Blue Cross Blue Shield’s interquartile range is $8,155 (P75 $25,367 minus P25 $17,210.9), UnitedHealth Group’s range is $11,020.5 (P75 $17,099.6 minus P25 $5,076.5), Cigna’s range is $15,084.5 (P75 $22,584.5 minus P25 $7,500), and Aetna’s range is narrow at $640 (P75 $912.3 minus P25 $229.3). Cigna shows the widest IQR and Aetna the tightest, indicating the most and least concentration of commercial rates, respectively.