C-Codes

C-codes are codes established by Medicare for certain medical devices. The C-codes offer the only way for CMS (Medicare) to properly track device costs for use in setting hospital outpatient APC payment levels. Use of C-codes by hospitals ensures accurate device costs are included in the cost calculation for future rates. 

C-codes were left in place through calendar year 2002. The 2002 data was most recently used to set Medicare's 2004 outpatient hospital payment rates. However, CMS did not require C-codes to be used in CY 2003.

For calendar year 2004, CMS suggested, but did not require, the use of C-codes. As a result, this data may or may not be in the claims used to calculate 2006 APC rates. Although Medicare has stated that the use of the reinstated C-codes is voluntary, Medicare is strongly encouraging hospitals to begin reporting these codes immediately. Specifically, Medicare states "hospitals should understand that providing complete and accurate information on the claims about the services that were furnished and the charges for those services is fundamental to our establishment of relative weights on which the payment for their services is based." 

It is important to note that billing of the C-code does not generate additional immediate reimbursement revenue for hospitals, however it will affect future payment levels. Inadequate representation of device costs will likely decrease these payment levels for device-dependent APCs. The C-codes must also be added to the hospital charges master with the appropriate cost to charge ratio and mark up. 

It is crucial that hospitals not only bill Medicare for devices/services using C-codes, but that they also accurately charge for these devices/services based on cost-to-charge ratios. Non-Medicare payors often use E-codes to accomplish this task, and charges are dependent on the facility's individual contracts with them.

Currently these are the C-Codes for Medtronic ENT products. If the facility has not done so already, you should encourage that C-codes be added to the charge master for all appropriate devices. 

The coding information below is listed for your convenience in reporting these services:

Medtronic ENT has provided this reimbursement information to the best of its knowledge, however it makes no guarantees concerning amount of reimbursement. It is always the provider's responsibility to determine appropriate codes and charges for insurance claims.