Question 1

What is HCPCS code C7546?

Accepted Answer

HCPCS code C7546 is "Rep nph/urt cath w/dil stric". Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation

Question 2

What category is C7546 in?

Accepted Answer

C7546 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C7546?

Accepted Answer

Use C7546 when billing for rep nph/urt cath w/dil stric. 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 C7546 covered by Medicare?

Accepted Answer

Coverage for C7546 (Rep nph/urt cath w/dil stric) 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 C7546?

Accepted Answer

Documentation for C7546 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).