HCPCS code C9766 is defined as:
Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed.
This is a Level II HCPCS code, introduced by the Centers for Medicare & Medicaid Services (CMS) to describe a specific endovascular procedure involving multiple techniques to restore blood flow in a vessel. It’s part of a series of codes (C9764–C9767) established in July 2020, with refinements in 2021, to address peripheral intravascular lithotripsy (IVL) procedures.
Key Components of C9766
Revascularization: The overarching goal—restoring blood flow in a blocked or narrowed vessel—via an endovascular approach (using catheters) or, less commonly, an open surgical method.
Intravascular Lithotripsy (IVL): A technique using sonic pressure waves to break up calcified plaque within the vessel, making it easier to treat.
Atherectomy: A procedure to physically remove plaque from the vessel wall, often using a specialized catheter.
Angioplasty (if performed): Balloon dilation of the vessel to further open it, bundled into the code when done in the same vessel(s).
Any Vessel(s): Unlike earlier versions of related codes (e.g., restricted to lower extremity arteries except tibial/peroneal), C9766 applies to any vessel where this combination of techniques is used, offering flexibility across vascular territories (e.g., coronary, peripheral, etc.), though it’s most commonly associated with peripheral arteries.
When to Use C9766
Use C9766 when the procedure involves all three elements—IVL, atherectomy, and potentially angioplasty—in the same vessel(s) during a single session.
The vessel(s) must be treated endovascularly (via catheter) or through an open approach, though endovascular is far more common for this code.
Documentation must clearly support:
Use of IVL to fracture calcified lesions.
Atherectomy to remove plaque.
Angioplasty (if performed) within the same vessel(s).
What’s Bundled?
Angioplasty: If performed in the same vessel(s) as the IVL and atherectomy, it’s included in C9766 and not billed separately.
Imaging Guidance: Fluoroscopy or other radiologic supervision and interpretation (e.g., 75962, 75968) is typically bundled into C9766 for Medicare patients under the Outpatient
Prospective Payment System (OPPS).
Access and Catheter Placement: Codes for vascular access or selective catheter placement (e.g., 36245–36248) are often bundled unless they represent a distinct procedural service (check payer rules).
Differentiating from Related Codes
C9766 is part of a family of IVL-related codes. Here’s how it compares:
C9764: IVL alone (with angioplasty if performed), no atherectomy or stenting.
C9765: IVL with stent placement (and angioplasty if performed), no atherectomy.
C9767: IVL with both stent placement and atherectomy (and angioplasty if performed).
C9766: IVL with atherectomy (and angioplasty if performed), no stenting.
If stenting occurs alongside IVL and atherectomy, use C9767 instead of C9766. The absence or presence of stenting is the key differentiator.
