C9796 HCPCS code: Repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis])
C9796 is the HCPCS Level II code for repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis]). 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 | P6C |
| Added | 2024-01-01 |
| Last action effective | 2024-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
What changed for C9796
- 2024-01-01: C9796 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 C9796?
C9796 is the HCPCS Level II code for repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis]). Short descriptor: "Rpr intst excl anrect fist".
Does Medicare cover C9796?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of C9796 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related C97 codes
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- C9725 — Placement of endorectal intracavitary applicator for high intensity brachytherapy
- C9726 — Placement and removal (if performed) of applicator into breast for intraoperative radiation therapy, add-on to primary breast procedure
- C9727 — Insertion of implants into the soft palate; minimum of three implants
- C9728 — Placement of interstitial device(s) for radiation therapy/surgery guidance (e.g., fiducial markers, dosimeter), for other than the following sites (any approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or multiple
- C9733 — Non-ophthalmic fluorescent vascular angiography
- C9734 — Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance
- C9735 — Anoscopy; with directed submucosal injection(s), any substance
- C9737 — Laparoscopy, surgical, esophageal sphincter augmentation with device (e.g., magnetic band)
- C9738 — Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)
- C9739 — Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants
- C9740 — Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants
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Next steps
- Run a reimbursement report for a device billed under C9796
- Watch C9796 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C9796
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.