Question 1

What is HCPCS code C9726?

Accepted Answer

HCPCS code C9726 is "Rxt breast appl place/remov". Placement and removal (if performed) of applicator into breast for intraoperative radiation therapy, add-on to primary breast procedure

Question 2

What category is C9726 in?

Accepted Answer

C9726 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C9726?

Accepted Answer

Use C9726 when billing for rxt breast appl place/remov. 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

What ICD-10 codes are commonly used with C9726?

Accepted Answer

Common ICD-10 diagnosis codes used with C9726 include: C18.0 (Malignant neoplasm of cecum), C18.1 (Malignant neoplasm of appendix), C18.2 (Malignant neoplasm of ascending colon), C18.3 (Malignant neoplasm of hepatic flexure). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is C9726 covered by Medicare?

Accepted Answer

Coverage for C9726 (Rxt breast appl place/remov) 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 6

What documentation is required for C9726?

Accepted Answer

Documentation for C9726 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).