HCPCS code C9796 — Rpr intst excl anrect fist.
Status: Active.
Effective Jan 1, 2024.
Source: CMS HCPCS Level II.
C9796
ActiveRpr intst excl anrect fist
Repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis])
Category:
Outpatient PPS
Section:
C-codes: Outpatient PPS
Effective:
Jan 1, 2024
Code type:
alphanumeric
OPPS Status:
J1
— Hospital Part B services paid through a comprehensive APC (C-APC)
OPPS APC:
5313
MUE — Medically Unlikely Edits
Maximum units of C9796 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 1 |
| Practitioner Services | 1 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NCCI Edits
The following codes cannot be billed together with C9796 without appropriate documentation.
| Column 2 Code | Modifier |
|---|---|
| G0181 | Modifier may bypass edit |
| G0182 | Modifier may bypass edit |
| G0463 | Modifier may bypass edit |
| G0471 | Modifier may bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)
Change History
Quarterly changes published by CMS. Revisions may affect the code description, coverage, or rate — review each quarter's changes before submitting claims.
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New Code 2024-Q1Rpr intst excl anrect fist