HCPCS C1874: Stent, coated/covered, with delivery system

Learn more about HCPCS code C1874 and how to properly use and bill for it by meeting the documentation and billing requirements listed in our short guide.

Use Code

## **What is HCPCS code C1874?** HCPCS code C1874 is a C-code with a full description of: Stent, coated/covered, with delivery system. C-codes are temporary codes created by the Centers for Medicare & Medicaid Services (CMS) for use in the Hospital Outpatient Prospective Payment System (OPPS) to report devices, drugs, and other items/services not yet covered by permanent codes. This code represents a coated or covered stent that is implanted in a blood vessel during coronary angioplasty, along with the system used to deliver and deploy it. This includes products like drug-eluting stents (DES) and covered stents used in various arteries (coronary, peripheral, etc.) to treat stenosis (narrowing) or other high-risk vascular conditions. For Medicare OPPS, payment for devices reported with C-codes is generally packaged into the payment for the primary procedure (like a percutaneous coronary intervention or angioplasty). However, reporting the code is crucial for cost tracking and to provide data that influences future reimbursement rates.

## **HCPCS code C1874 documentation requirements** Thorough documentation is essential for proper billing and compliance. Key elements that should be clearly documented in the patient's medical record for a procedure involving C1874 include: - **Medical necessity**: Clear documentation of the patient's condition (e.g., diagnosis, symptoms, previous treatment failures like balloon angioplasty without stent or coronary artery bypass surgery) that supports the need for a stent. - **Procedure note**: A detailed operative report that includes the type and brand name of the stent used (e.g., drug-eluting, covered), the specific vessel(s) where the stent was placed, the size and number of stents implanted, a confirmation that the stent was delivered using its delivery system. and the success of the stent placement and restoration of blood flow. - **Implant record**: Documentation of the unique device identifier (UDI) or lot number of the implanted device, as well as the manufacturer's name. - **Diagnosis codes (ICD-10-CM)**: The specific diagnosis codes that justify the procedure (e.g., those related to coronary artery disease, unstable angina, or peripheral artery disease).

## **C1874 billing requirements** C1874 billing is subject to specific rules, particularly for Medicare's OPPS: - **Facility claims**: C1874 is used by hospital outpatient departments (facilities) on the claim form (UB-04/CMS-1450). - **Physician billing**: Physicians generally use permanent CPT codes to bill for the professional services of placing the stent (e.g., percutaneous coronary intervention codes like 92928-92934), and do not bill for the device itself with C1874. - **Billing separately**: While the payment for C1874 is typically packaged, hospitals are required to report the code and the corresponding charge for the device to provide accurate cost data to CMS. - **Revenue code**: The code must be billed with an appropriate revenue code that identifies the type of service or supply provided. - **Modifiers**: Depending on the payer and the specific context of the procedure, modifiers may be necessary. Always check payer-specific instructions.

## **Other relevant codes** - **C1875**: Stent, coated/covered, without delivery system - **C1876**: Stent, non-coated/non-covered, with delivery system - **C1877**: Stent, non-coated/non-covered, without delivery system - **C1884**: Embolization protective system - **C9605**: Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy, and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure) - **C9608**: Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy, and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)

Frequently asked questions

C1874 is for a coated/covered stent (e.g., a drug-eluting stent or a stent graft), while C1876 is for a non-coated/non-covered stent (e.g., a bare-metal stent). Both include the delivery system.

As a C-code, C1874 is recognized by Medicare for billing, but payment for the device is typically packaged into the payment for the overall primary procedure (e.g., the stenting or angioplasty CPT code) under the Outpatient Prospective Payment System (OPPS). It is not usually paid for as a separate, direct reimbursement.

No. C-codes are generally designed for use by hospital outpatient departments (facilities) to report devices for cost-tracking and payment packaging purposes under the OPPS. The physician bills for the professional service of the procedure using CPT codes.