Summary & Overview
HCPCS C9746: Transperineal Implantation of Adjustable Balloon Continence Device
HCPCS Level II code C9746 identifies transperineal implantation of a permanent adjustable balloon continence device, including cystourethroscopy and/or fluoroscopy when performed. This procedural code captures a minimally invasive surgical option for managing urinary incontinence through placement of an adjustable implantable balloon via a transperineal approach. Nationally, the code is relevant for surgical specialties managing complex urinary continence cases and for facility billing in ambulatory surgery centers and hospital operating rooms.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for device implantation, expected sites of service, and the service type captured by the code. The publication also summarizes common reimbursement and coverage considerations, benchmark metrics where available, and recent policy updates affecting implantable continence device procedures. Clinical context provided includes the role of cystourethroscopy and fluoroscopy as adjuncts during implantation. Data not provided in the input—such as specific payer policy language, modifier usage, associated taxonomies, ICD-10 diagnoses, and related codes—is noted as unavailable for this entry.
Billing Code Overview
HCPCS Level II code C9746 describes transperineal implantation of a permanent adjustable balloon continence device, performed with cystourethroscopy when performed and/or fluoroscopy when performed. This procedure is a surgical implantation intended to treat urinary incontinence by placing an adjustable balloon device via a transperineal approach.
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Service type: Surgical implantation of a permanent adjustable continence device
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Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old female with refractory stress urinary incontinence after prior conservative therapy (pelvic floor physical therapy, pessary) and failed or contraindicated sling procedures. She reports persistent urinary leakage with exertion and cough, impacting quality of life. Preoperative evaluation includes urodynamics demonstrating stress-predominant incontinence, pelvic exam, laboratory testing, and counseling on options. The procedure performed is C9746 — transperineal implantation of a permanent adjustable balloon continence device — typically done in an ambulatory surgery center or hospital outpatient setting under regional or general anesthesia. Intraoperative cystourethroscopy (when performed) confirms bladder integrity and urethral anatomy; fluoroscopy (when performed) guides device positioning and adjustment. Postoperative workflow includes brief recovery, voiding trial, device inflation/adjustment as needed during follow‑up visits, and documentation of device model, volume adjustments, and counseling on activity restrictions and signs of complications (infection, erosion, urinary retention).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the day of a procedure |