Summary & Overview
HCPCS C9747: Transrectal Prostate Ablation with HIFU and Imaging Guidance
HCPCS Level II code C9747 labels transrectal high intensity focused ultrasound (HIFU) ablation of the prostate with imaging guidance, a minimally invasive therapeutic option for targeted prostate tissue destruction. Nationally, this code matters as payers assess coverage criteria and reimbursement for newer ablative technologies that may offer alternatives to traditional surgery or radiation.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service represented by the code, payer coverage context, and what to expect in claims processing and site-of-service considerations. The publication summarizes commonly used modifiers (input provided) and flags locations where additional coding detail or diagnosis linkage is required.
This analysis provides benchmarks for service line classification, typical settings for delivery, and points of attention for billing and documentation. It also outlines where input data was not provided and notes items requiring payer-specific policy review. The content is oriented to national stakeholders — coding staff, revenue cycle professionals, and clinical leaders — seeking a clear, actionable description of HCPCS Level II code C9747 and its role in prostate ablation services.
Billing Code Overview
HCPCS Level II code C9747 describes ablation of the prostate performed transrectally using high intensity focused ultrasound (HIFU), including imaging guidance. This procedure is a targeted, minimally invasive thermal ablation of prostatic tissue delivered via a transrectal approach and performed with integrated imaging to localize and monitor treatment.
Service type: Therapeutic ablative prostate procedure (HIFU)
Typical site of service: Outpatient surgical suite or ambulatory surgical center, with possible performance in hospital outpatient departments when clinically indicated.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old male with symptomatic localized benign prostatic hyperplasia (BPH) or localized prostate cancer who has persistent urinary obstructive symptoms or seeks a focal oncologic treatment alternative. The patient undergoes pre-procedure evaluation including history and physical, prostate-specific antigen (PSA) testing, transrectal ultrasound and multiparametric prostate MRI for lesion localization and staging. On the day of service the patient is brought to an outpatient ambulatory surgical center or hospital outpatient department for transrectal high intensity focused ultrasound (C9747) under imaging guidance. Conscious sedation or monitored anesthesia care is provided, and real-time imaging guides the targeted HIFU ablation zones. Post-procedure recovery includes observation for urinary retention, hematuria, infection, and pain; catheter placement may be required temporarily. Follow-up includes PSA monitoring and repeat imaging or targeted biopsy as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical expectations for C9747 and must be documented with supporting operative note. |