  CVAC System
Calyxo CVAC® Coding & Reimbursement Hub
How to use this page
- Start here (Overview): quick orientation + what’s unique about CVAC® coding.
- Physician Coding tab: CPT® selection logic, documentation language, and common pitfalls.
- Facility Coding tab: when C9761 applies, device billing considerations, and charge capture tips.
- Right-side “Additional Resources”: Calyxo reimbursement resources, product info, and supporting articles/PDFs.
Kidney stone clearance coding: what’s different with CVAC®
CVAC®-enabled procedures introduce a distinct facility reporting pathway under OPPS with HCPCS C9761 when the procedure includes steerable vacuum aspiration using the required technology.
The key operational reality: professional billing and facility billing diverge. Physicians generally report standard ureteroscopy/lithotripsy CPT® codes, while facilities may have a separate primary procedure code when the full C9761 requirements are met.
Key takeaways for urology practices
- “Suction” is not enough: C9761 is intended for steerable vacuum aspiration with the required device/workflow—not simply any suction-enabled ureteroscopy or suction sheath.
- Facility vs physician rules are different: the facility may report C9761 (when supported), while the physician reports the applicable CPT® (e.g., ureteroscopy with lithotripsy).
- Documentation must “tell the story”: approach + lithotripsy + steerable vacuum aspiration must be clearly documented and consistent across the op note and facility record.
- C1747 pass-through ended 12/31/25 (Medicare): HOPD: continue to report C1747 (device) and bill device charges on its own line when billing C9761 (procedure), even though payment is packaged. ASC (traditional Medicare): do not report C1747; include device cost in your C9761 charge.
- Compliance is part of the economics: incorrect C9761 use can trigger denials, audits, and distorted internal ROI assumptions.
What CVAC® is (in one breath)
Calyxo CVAC® System is an all-in-one kidney stone treatment approach designed to improve stone clearance by combining irrigation and vacuum aspiration to continuously clear fragments during and after laser lithotripsy, supporting a “leave no stone behind” workflow.
Tools to help you (fast)
- Calyxo Reimbursement Resource Hub: billing basics, modifiers, and facility reporting guidance.
- CVAC® System product overview: workflow summary and clinical rationale.
Transparency
- This hub format is educational and designed to reduce coding confusion and denials risk.
- Always validate payer-specific requirements and your current-year OPPS tables before go-live changes.
Physician Coding
Professional reporting for CVAC® cases generally follows standard ureteroscopy and lithotripsy CPT® rules (e.g., 52353/52356). The physician does not report C9761 (facility-only). Prior auth tip: when required, request CPT for the physician and C9761 for the facility—make clear C9761 is being authorized for the facility, not the physician.
General concept: Choose CPT® based on what you did (ureteroscopy/pyeloscopy, lithotripsy, stent, etc.).
Common ureteroscopy/lithotripsy codes (examples)
- 52353 – Ureteroscopy with ureteral/renal pelvic lithotripsy
- 52356 – Ureteroscopy with lithotripsy and indwelling ureteral stent insertion
Documentation language that helps:
- State lithotripsy performed (laser, etc.).
- Describe stone burden/location and outcome (residual fragments, stone-free intent, etc.).
- If used, describe the CVAC® workflow as a technique for fragment evacuation (without implying a separate physician code).
- Scope & access: ureteroscopy and/or pyeloscopy performed.
- Lithotripsy performed: modality (e.g., laser) and primary stone location(s).
- Evacuation method: clearly describe fragment evacuation/aspiration technique used.
- Stent status: placed vs not placed, laterality if relevant.
- Results: residual fragments, stone free intent, complications, and follow-up plan.
Practical point: If the physician op note says “suction” but the facility bills C9761, you’ve created a mismatch that invites denial.
- Underspecifying the work: “URS with suction” without clarifying lithotripsy, renal vs ureteral location, or outcome.
- Stent ambiguity: stent placed but not clearly documented (or vice versa).
- Inconsistent terminology: cognitive shorthand in the op note that doesn’t map to clean claims language.
- Assuming facility edits don’t affect you: facility denials often trigger rebilling cycles and physician AR delays.
Facility Coding
Facility reporting is where CVAC® becomes uniquely sensitive. When the documented service meets the long descriptor requirements, the facility may report HCPCS C9761 as the primary procedure code under OPPS (payer rules vary). Set an appropriate facility charge: even when payment is packaged, accurate charges support correct payment methodologies and future rate-setting.
C9761 is intended for: cystourethroscopy with ureteroscopy/pyeloscopy, lithotripsy, and steerable vacuum aspiration using the required technology (per the code descriptor).
C9761 is often misapplied when:
- Only a suction access sheath or suction port is used (no steerable vacuum aspiration catheter workflow).
- Documentation describes “suction” generally, without supporting the specific steerable vacuum aspiration method.
- The device/workflow used does not match the code’s required elements.
Bottom line: C9761 is a procedure code, not a “better 52356.” It must be supported by documentation of the distinct technique and required device use.
Use both codes when appropriate: C9761 is the procedure (facility OPPS). C1747 is the device. They are not interchangeable.
- Hospital Outpatient (HOPD): Report C9761 and C1747. Even though pass-through ended 12/31/25, continue to bill device charges on the C1747 line (packaged payment, but CMS uses the data).
- ASC (traditional Medicare): Do not bill C1747 in 2026; include device cost in the C9761 charge. (Claims may reject C1747.)
- Commercial payers: follow contract terms—some still require C1747 and may require an invoice when billed separately.
Note: C1889 is generally a fallback only when no more accurate device code exists; for CVAC, C1747 is the closest available device code.
To support C9761 and reduce denials, ensure the facility record clearly captures:
- Procedure elements: cystourethroscopy + ureteroscopy/pyeloscopy + lithotripsy performed.
- Steerable vacuum aspiration: explicit statement that steerable vacuum aspiration was performed.
- Required device/workflow: note use of the device consistent with the C9761 descriptor requirements.
- Stone location/burden and outcomes: renal pelvis/calyces involvement and clearance intent.
- Device charge capture: if billing C1747 (when applicable), ensure appropriate itemization and support per facility policy.
- Record alignment: physician op note + nursing + supply + charge master should match the same story.
Why this matters: when records tell different stories, payers default to denial or downcoding.
- “Suction” wording without “steerable vacuum aspiration”: weak support for C9761.
- Device not documented: charge posted but not supported by the clinical record or supply log.
- Procedure mismatch: facility bills C9761 but physician documentation reads like standard URS only.
- Assuming payer parity: commercial policies may not mirror Medicare OPPS treatment.
Operational best practice: add a 20-second post-op “billing attestation” line for the key C9761 elements.
- Medicare OPPS: validate current-year edits and device payment status for your billing configuration.
- Commercial payers: confirm whether they recognize C9761 or require alternative reporting pathways.
- Denial tracking: log denials by payer early; build a short internal “payer rules” addendum for schedulers/coders.
