Summary & Overview

HCPCS C9761: Steerable Ureteral Catheter with Lithotripsy and Vacuum Aspiration

HCPCS Level II code C9761 represents an advanced endoscopic urologic procedure: cystourethroscopy combined with ureteroscopy and/or pyeloscopy, lithotripsy, and ureteral catheterization specifically using a steerable ureteral catheter for vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra as applicable. This code captures a procedure that integrates visualization, stone fragmentation, and catheter-directed aspiration in one operative encounter, and therefore is relevant for hospitals, ambulatory surgery centers, and urology practices nationwide.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of national coding context and clinical scope, standard sites of service, and common modifier considerations. The publication outlines benchmarks for utilization and reimbursement where available, highlights relevant policy and coverage trends from major payers, and provides clinical context for when this combined approach is used versus alternative stone management techniques.

This summary serves clinicians, billing professionals, and policy analysts who need a concise reference to the code’s clinical intent, expected care settings, and the payer landscape that typically governs coverage and claim adjudication decisions. Data not provided in the input (such as associated taxonomies, ICD-10 diagnoses, and related codes) are noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9761HCPCS Level IIurologylithotripsyureteroscopycystourethroscopyvacuum-aspirationsteerable-ureteral-catheter

Billing Code Overview

HCPCS Level II code C9761 describes a cystourethroscopy with ureteroscopy and/or pyeloscopy that includes lithotripsy and ureteral catheterization using a steerable ureteral catheter for vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra as applicable. The procedure requires use of a steerable ureteral catheter and combines endoscopic visualization (cystourethroscopy, ureteroscopy/pyeloscopy), intracorporeal or intraluminal lithotripsy, and catheter-directed vacuum aspiration for stone or debris removal.

Service Type: Endoscopic urologic stone management with steerable ureteral catheter and vacuum aspiration

Typical Site of Service: Hospital operating room, ambulatory surgery center, or endoscopy suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents with symptomatic urolithiasis involving the renal pelvis and proximal ureter causing persistent flank pain, recurrent hematuria, and impaired drainage on imaging. Prior conservative therapy including hydration and medical expulsive therapy failed. Pre-procedural evaluation includes urinalysis, urine culture, basic metabolic panel, coagulation profile, and cross-sectional imaging (CT urogram or noncontrast CT). Under general or regional anesthesia in an operating room or ambulatory surgery center, the urology team performs a cystourethroscopy to inspect the bladder and urethra, then advances a steerable ureteral catheter and ureteroscope into the ureter and renal collecting system. Lithotripsy is performed (laser or ultrasonic) to fragment calculi. The steerable ureteral catheter is used for vacuum-assisted aspiration to remove stone fragments. Temporary ureteral stent placement or nephrostomy tube may follow for drainage if indicated. Typical sites of service include the inpatient operating room, ambulatory surgery center, or hospital outpatient department depending on comorbidity and expected recovery. Common clinical workflow steps: pre-op evaluation and consent, anesthesia induction, cystourethroscopy and ureteroscopy/pyeloscopy with lithotripsy and steerable vacuum aspiration using a steerable ureteral catheter (code C9761 describes the required steerable catheter), specimen handling for stone analysis, postoperative monitoring, and discharge with instructions and follow-up imaging as indicated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for `C9761` (document reason and increased work).
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for reasons unrelated to the procedure complexity.
`50`	Bilateral procedure	Use when identical procedure is performed on both renal units during same operative session.
`51`	Multiple procedures	Use when `C9761` is billed with unrelated additional procedures in the same session (append modifier per payer rules).
`52`	Reduced services	Use when procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when procedure is started but terminated due to extenuating circumstances.
`59`	Distinct procedural service	Use to indicate a procedure or service not normally reported together but performed under distinct circumstances.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of `C9761`.
`73`	Discontinued outpatient hospital/ASC prior to anesthesia	Use when scheduled `C9761` is cancelled after patient prep but before anesthesia.
`74`	Discontinued outpatient hospital/ASC after anesthesia	Use when `C9761` is discontinued after induction of anesthesia.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an assistant from the listed provider types assists during `C9761` per payer allowance.
`59`	Distinct procedural service	See above — used to indicate a separate and distinct service from other billed procedures.
`LT`	Left side	Use to indicate the left anatomical site when laterality reporting is required.
`RT`	Right side	Use to indicate the right anatomical site when laterality reporting is required.

Taxonomy Code	Specialty	Notes
`208600000X`	Urology	Primary specialty performing ureteroscopy, pyeloscopy and lithotripsy.
`2087P0200X`	Pediatric Urology	Performs similar procedures in pediatric population when applicable.
`207RH0000X`	Surgical Oncology	May be involved when complex stone disease overlaps with oncologic urinary tract pathology.
`363L00000X`	Anesthesiology	Provides general or regional anesthesia for `C9761`.
`261QM0800X`	Physician Assistant	Often assists the urologist in operative care and intraoperative tasks.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N20.0`	Calculus of kidney	Represents renal stones targeted by pyeloscopy and lithotripsy with aspiration.
`N20.1`	Calculus of ureter	Ureteral stones addressed by ureteroscopy and lithotripsy with steered catheter aspiration.
`N20.2`	Calculus of kidney with calculus of ureter	Combined renal and ureteral stone disease often necessitating combined cystourethroscopy with ureteroscopy/pyeloscopy.
`N21.0`	Calculus in bladder	Bladder stones may be inspected/removed during cystourethroscopy component of the procedure.
`N13.6`	Pyonephrosis	Infected obstructed collecting system where endoscopic drainage and removal of obstructing stones may be indicated with caution.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52332`	Cystoureteroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy (ureteral access sheath may be used); with removal of stone fragments from ureter and/or renal pelvis	Commonly performed alternative or complementary endoscopic lithotripsy; may be billed when standard ureteroscopic lithotripsy without steerable vacuum catheter is performed.
`50590`	Lithotripsy, extracorporeal shock wave (ESWL)	Nonendoscopic treatment option for renal calculi; may be performed prior to or instead of ureteroscopic lithotripsy depending on stone characteristics.
`52320`	Cystourethroscopy, with removal of foreign body from bladder, with or without irrigation and instillation	May be used for isolated bladder stone removal if stone burden is confined to bladder rather than upper tract.
`51702`	Placement of ureteral catheter (single)	Represents initial ureteral catheterization and may be reported when separate from primary endoscopic lithotripsy session.
`52000`	Cystourethroscopy (separate procedure)	Diagnostic cystourethroscopy performed alone or prior to therapeutic ureteroscopy; may be billed if performed as a distinct service.