Question 1

What is HCPCS code C7541?

Accepted Answer

HCPCS code C7541 is "Ercp w/ pancreatoscopy". Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)

Question 2

What category is C7541 in?

Accepted Answer

C7541 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C7541?

Accepted Answer

Use C7541 when billing for ercp w/ pancreatoscopy. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is C7541 covered by Medicare?

Accepted Answer

Coverage for C7541 (Ercp w/ pancreatoscopy) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for C7541?

Accepted Answer

Documentation for C7541 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).