C1813 HCPCS code: Prosthesis, penile, inflatable
C1813 is the HCPCS Level II code for prosthesis, penile, inflatable. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | C codes — Outpatient PPS (hospital outpatient temporary codes) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 53 |
| BETOS category | D1A — Medical/surgical supplies |
| Added | 2001-04-01 |
| Last action effective | 2004-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Anatomic Consideration |
| practitioner claims | 1 | Anatomic Consideration |
What changed for C1813
- 2001-04-01: C1813 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code C1813?
C1813 is the HCPCS Level II code for prosthesis, penile, inflatable. Short descriptor: "Prosthesis, penile, inflatab".
Does Medicare cover C1813?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of C1813 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related C18 codes
- C1814 — Retinal tamponade device, silicone oil
- C1815 — Prosthesis, urinary sphincter (implantable)
- C1816 — Receiver and/or transmitter, neurostimulator (implantable)
- C1817 — Septal defect implant system, intracardiac
- C1818 — Integrated keratoprosthesis
- C1819 — Surgical tissue localization and excision device (implantable)
- C1820 — Generator, neurostimulator (implantable), with rechargeable battery and charging system
- C1821 — Interspinous process distraction device (implantable)
- C1822 — Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system
- C1823 — Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
- C1824 — Generator, cardiac contractility modulation (implantable)
- C1825 — Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s)
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Next steps
- Run a reimbursement report for a device billed under C1813
- Watch C1813 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C1813
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.