Question: Must we report C codes to receive separate payment for devices?
Kansas Subscriber
Answer: C codes serve to improve collection of device cost data but do not allow for separate payment of the devices they describe. The facility receives reimbursement for outpatient care, based on APC rates, only for the procedures the physician performs.
In 2005, however, CMS mandated that you must bill certain C codes with CPT codes for all device-dependent APCs. If a hospital outpatient bill includes a device-related CPT procedure code, but you do not report the HCPCS II C code for the associated device, CMS will reject the claim and deny all payment.
As noted, CMS requires the C codes to collect charge data for these devices to set future reimbursement rates.
Medicare has established outpatient coding edits dictating which specific C codes you should bill with which CPT procedure codes. The list of coding edits is not all-inclusive, and Medicare will add edits to the list on a quarterly basis along with the quarterly Outpatient Coding Editor (OCE) release.
You can find a list of current device and procedures edits on the CMS Web site: http://www.cms.hhs.gov/HospitalOutpatientPPS/02_device_procedure.asp#TopOfPage.
