Common professional CPT® codes

• 52353 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included).
• 52356 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (e.g., Gibbons or double-J type).

Reporting the additional suction/aspiration work

• For the additional work associated with steerable vacuum aspiration, physicians may report the unlisted procedure code 53899 (unlisted procedure, urinary system; paid by report) or append modifier -22 to 52353/52356 to indicate work greater than typically required.
• A short description of the extra work performed should be added to Box 19 of the claim to assist proper processing. Be prepared to provide clinical documentation if requested by the payer.

Important physician rule

• C9761 is not a physician professional claim code. It is a facility procedure code used by HOPDs and ASCs when supported by documentation and payer policy.
• Physicians should code based on the actual work performed: ureteroscopy/pyeloscopy, lithotripsy, stent placement, ureteral catheterization, stone manipulation/removal, or other documented services.

Prior authorization practical point

• When authorization is required, make sure the professional authorization and facility authorization are aligned. The physician side may reference CPT® 52353 or 52356, while the facility side may require C9761.

Report diagnosis codes that reflect the reason for the encounter and code to the highest specificity supported by the medical record.

• N20.0 – Calculus of kidney
• N20.1 – Calculus of ureter
• N20.2 – Calculus of kidney with calculus of ureter

Additional diagnoses may be appropriate when supported by the record and relevant to medical necessity, operative complexity, payer policy, or patient risk.

Physician documentation should support the professional CPT® code and, when the facility reports C9761, should also support the facility's C-code logic.

What the operative note should state clearly

• Procedure performed: cystourethroscopy with ureteroscopy and/or pyeloscopy, lithotripsy, stent placement if performed, and laterality.
• Device identification: the Axis II Clerix™ suction-integrated ureteroscope, named exactly. If HOOVER FANS was also used, name it too — the combination still reports C9761 only at the facility level.
• Suction/vacuum aspiration: describe direct in-scope suction, irrigation/suction capability, and vacuum aspiration of stone fragments, dust, debris, or fluid.
• Steerability/catheter language: document that a steerable ureteral catheter / suction-integrated ureteroscope was used when the facility intends to support C9761.
• Stone burden and outcome: location, size/burden, fragmentation, evacuation/aspiration, residual burden, complications, and follow-up plan.

Suggested claim-support phrase:
Procedure performed using the Dornier Axis II Clerix suction-integrated single-use ureteroscope with lithotripsy, suction/irrigation capabilities, and steerable ureteral catheterization for vacuum aspiration of stone fragments and dust.

Modifier use

• Modifier -59 / -XS: may be required for distinct procedural services when payer rules allow. Do not report 52356 and 52353 on the same side simply by adding -59/-XS.
• Modifier -22: may be considered only when documentation supports substantially greater work than typical, with concrete detail such as increased operative time, difficult anatomy, unusually large stone burden, or extensive aspiration/evacuation work.
• Modifiers -LT / -RT / -50: use laterality and bilateral reporting according to payer-specific rules.

Global period awareness

• Most ureteroscopy stone procedures have a 0-day global period. Common exceptions include ESWL and PCNL procedures, which typically have 90-day globals.

Common physician-side pitfalls

• Generic language: "URS with suction" is too weak to support facility C9761 billing.
• Device omitted: failure to identify the Axis II Clerix™ by name weakens facility claim support.
• CPT/HCPCS role confusion: physicians report CPT® professional services; facilities report C-codes when applicable.
• Record mismatch: physician note, facility record, supply log, and charge capture must tell the same story.

The high-confidence rule: who bills what

• Physician / professional claim: report the applicable CPT® ureteroscopy/lithotripsy code, commonly 52353 or 52356. Physicians do not bill C9761.
• Facility (HOPD or ASC): report C9761 when all required elements are met and documented.
• Clerix + HOOVER FANS in the same case: report C9761 only. C9761 and C8014 are both status J1 (primary/comprehensive) and cannot be reported together on the same claim.
• Device code in the HOPD: for Medicare HOPD claims, report C1747 with the cost of the Clerix device for tracking purposes. The expected Medicare payment on the C1747 line is $0 because payment is packaged.
• ASC limitation: do not report C1747 on Medicare ASC claims. Commercial payer rules may differ, so verify payer-specific instructions.

C9761 descriptor

C9761 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if necessary, with use of steerable ureteral catheter or suction-integrated ureteroscope.

When C9761 is supported for Axis II Clerix™

• Services were provided in the HOPD or ASC.
• The Axis II Clerix™ suction-integrated ureteroscope was used, and the documentation identifies it by name.
• Either 52353 or 52356 work was performed.
• The physician documented that a suction-integrated ureteroscope / steerable ureteral catheter with vacuum aspiration was used to perform the procedure.

Related codes for context

• C8014 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy, including use of a suction enabled ureteral access sheath, with irrigation (if performed). Applies to sheath-only cases (e.g., HOOVER FANS with a standard scope) — not to Clerix cases.
• C1747 – Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable). The device code; packaged payment.

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Site of Service: What Drives Facility Payment (Q3 2026, national averages)

• HOPD: C9761 is status J1 (comprehensive), approx. $9,672. All covered Part B services on the claim are packaged with the primary service.
• ASC: C9761 is device-intensive (payment indicator J8), approx. $6,612.
• Comparison: traditional lithotripsy (52353/52356) pays approx. $5,478 HOPD / $2,730 ASC; the sheath-only code C8014 pays approx. $5,478 HOPD / $3,452 ASC.

Charge Capture Tips: Common Misses That Trigger Denials

• Reporting C9761 and C8014 together: never — the scope code (C9761) is the only reportable procedure when both devices are used.
• C1747 on Medicare ASC claims: not required; may trigger rejections or invoice requests — remove per payer instruction.
• Missing C1747 on Medicare HOPD claims: report it with device cost to support tracking and future rate setting.
• Generic suction language: the record must name the Clerix and describe steerable vacuum aspiration.

ASC and HOPD outpatient diagnosis reporting: report ICD-10-CM codes that reflect the reason for the encounter/surgery and code to the highest level of specificity supported by the record.

• N20.0 – Calculus of kidney
• N20.1 – Calculus of ureter
• N20.2 – Calculus of kidney with calculus of ureter

For outpatient surgery, first-list the diagnosis that best explains the encounter. Do not code probable, suspected, or rule-out diagnoses unless payer rules and official guidance allow.

Documentation checklist: what must be present to support C9761

• Cystourethroscopy with ureteroscopy and/or pyeloscopy was performed.
• Lithotripsy was performed.
• A suction-integrated ureteroscope / steerable ureteral catheter with vacuum aspiration was used.
• The record identifies the device by name: Axis II Clerix™.
• The record describes aspiration/evacuation of stone fragments, dust, debris, or fluid from the kidney/collecting system as applicable.
• If HOOVER FANS was also used, it is named in the record — but the facility claim still reports C9761 only.

Claim remarks / internal billing note

Consider including this wording in Box 19 of the CMS-1500, FL 80 of the UB-04, or the internal billing note when supported by documentation and payer process:

Procedure performed using the Dornier Axis II Clerix suction-integrated single-use ureteroscope with lithotripsy, suction/irrigation capabilities, and steerable ureteral catheterization for vacuum aspiration.

Record alignment

• Physician operative note, nursing documentation, supply log, device record, charge capture, and claim lines should all identify the same procedure and device story.
• Do not let the facility claim look like a C9761 procedure if the op note reads like ordinary URS with generic suction.

Payment and site-of-service considerations

• C1747 in the HOPD: for Medicare HOPD claims, report C1747 and the cost of the device for tracking purposes. The C1747 line is expected to pay $0 because payment is packaged. Hospital reporting is factored into cost allocation for the following year and may support future rate adjustments.
• C1747 in the ASC: do not report C1747 on Medicare ASC claims. ASC payment is calculated as a percentage of the hospital APC and ASC device reporting does not factor into rate setting; some MACs/payers may reject the claim or require an invoice when device pass-through codes are present. Commercial payer rules may differ.
• C9761 payment status: C9761 remains at its assigned APC for Q3 2026 (status J1 in the HOPD; device-intensive J8 in the ASC).
• Payer variation: commercial and Medicare Advantage plans may apply different edits, authorization rules, device-code expectations, or invoice requirements.

Facility denial workflow

• Step 1: review the denial reason and confirm whether the claim, authorization, place of service, and documentation support the billed pathway.
• Step 2: correct what can be corrected. Confirm correct POS/site of service, Axis II Clerix™ use documented by name, physician code 52353 or 52356, and documentation of a suction-integrated ureteroscope / steerable catheter with vacuum aspiration.
• Step 3: check Box 19 or UB-04 FL 80 remarks for the Clerix wording when appropriate; correct and appeal if needed.
• Second denial: contact PRS using the denial support process.

Common facility-side pitfalls

• Billing C9761 without the full descriptor: suction alone is not enough.
• Missing device identity: claim implies a suction-integrated scope but the record does not name the Axis II Clerix™.
• C9761/C1747 substitution error: treating the procedure code and device code as alternatives rather than distinct claim elements, or reporting C1747 on Medicare ASC claims when it should only be reported for Medicare tracking in the HOPD.
• Reporting C8014 alongside C9761: when Clerix and HOOVER FANS are used together, only C9761 is reported.
• Record mismatch: physician note, nursing documentation, supply log, chargemaster, and claim lines do not align.