Table of content for "Kidney histotripsy w/image" (HCPCS C9790)
General information on the “C9790” code
HCPCS Code: C9790
Long Description: Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including image guidance
Short Description: Kidney histotripsy w/image
Original information is taken from C9790 page
Pricing indicators
Pricing Indicator Code 1: 53 – Statute
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Statute Number: 1833(t)
Cross Reference Code 1: 0888T ;
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): P1G – Major procedure - Other
Type Of Service 1: 6 – Therapeutic radiology
Type Of Service 2: F – Ambulatory surgical center (facility usage for surgical services)
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20231001
Code Effective Date: 20240701
Termination Date: 20240630
Action Code: D – Discontinue procedure or modifier code