HCPCS code C1726 – Non-vascular balloon dilatation catheter

Key takeaways

HCPCS code C1726 reports a non-vascular balloon dilatation catheter, the device used to widen a narrowed GI, biliary or urinary passage.

C1726 is a packaged device code with status indicator N, so it gets no separate OPPS payment. Its pass-through status ended in the early 2000s.

Report C1726 on the same hospital outpatient claim as the dilation procedure, and recheck its status indicator in each quarterly OPPS Addendum B.

Pabau’s billing software keeps device details and claims on one patient record, so the catheter line travels with its procedure.

HCPCS code C1726: What the code covers

HCPCS code C1726 is the CMS Level II code for a catheter, balloon dilatation, non-vascular. Hospitals report it when a balloon-tipped catheter widens a narrowed passage outside the blood vessels, such as the esophagus, a bile duct or a ureter.

Per the CMS HCPCS Level II code set, C-codes are reported on institutional outpatient claims. They are not CPT codes, and they do not belong on professional claims.

C1726 started life in 2001 as one of the original transitional pass-through device categories. That status expired in the early 2000s. Today CMS packages the catheter’s cost into the payment for the dilation procedure, so the C1726 line carries no separate payment.

The table below summarizes the key attributes of the code.

C1726 carries status indicator N (packaged) in the October 2026 OPPS Addendum B. CMS can change it in any quarterly update, so recheck each quarter.

What C1726 covers and what it does not

C1726 covers the balloon dilatation catheter itself when it is used outside the vascular system. The code applies when the device meets these characteristics.

• Device type: a catheter with an inflatable balloon, designed to dilate a stricture or narrowing
• Anatomy: a non-vascular passage, such as the esophagus, colon, bile or pancreatic duct, ureter or urethra
• Use setting: used during a hospital outpatient procedure billed under OPPS

The code does not cover the following:

• Vascular balloon catheters, such as non-laser transluminal angioplasty catheters, which CMS reports under C1725
• Non-vascular balloon tissue dissector catheters, which have their own code, C1727
• Devices used during an inpatient stay (Part A claims)
• Devices on professional claims from a physician office
• The dilation procedure itself, which is reported with its own CPT code

When a device does not match the descriptor exactly, find the correct HCPCS code before the claim goes out. A balloon tissue dissector, for example, belongs under C1727. A mismatched C-code distorts the cost data CMS uses to set procedure rates, and it can surface in a RAC or MAC audit.

Clinical procedures that use C1726

C1726 is reported alongside the CPT code for the dilation procedure. The CPT code describes the service, and C1726 records the catheter used to perform it. For esophageal dilation during EGD, that pairing is usually CPT 43249 plus C1726.

Typical non-vascular dilation procedures include the ones below. The CPT examples are common pairings, not a fixed list, so confirm each one against the operative note.

• GI tract: esophageal balloon dilation during EGD (CPT 43249) or flexible esophagoscopy (CPT 43220), and colonic stricture dilation during colonoscopy (CPT 45386)
• Biliary and pancreatic tract: balloon dilation of a duct or the ampulla during ERCP (CPT 43277)
• Urinary tract: treatment of a ureteral stricture during ureteroscopy (CPT 52344), and balloon dilation of a urethral stricture

Vascular angioplasty is not C1726 territory. Those catheters fall under C1725 and related codes, so check the descriptor on the device label before you assign one.

On the UB-04, the procedure code and C1726 belong on the same claim. Hospitals typically report the catheter under a supply revenue code, such as 0272 (sterile supply) or 0270 (general classification), per their chargemaster and MAC guidance.

Where C1726 can be billed: OPPS vs. non-OPPS settings

C-codes were created for the OPPS framework. CMS uses them to capture device costs on hospital outpatient claims, which is why the care setting decides whether C1726 belongs on a claim.

When a hospital outpatient department reports C1726, the claim is filed on the UB-04 and adjudicated under OPPS. The catheter line typically processes with no separate payment. That is expected for a packaged code, and it is not a denial.

How C1726 is paid: Packaging under OPPS

Pass-through payment is a CMS mechanism that pays separately for new, costly devices for a limited period, on top of the procedure’s APC rate. C1726 was one of the original device categories CMS created for it in 2001.

That status was transitional by design. Pass-through for C1726 expired in the early 2000s, and CMS then folded the catheter’s cost into the procedure payments. C1726 is not on the current list of devices with pass-through status (status indicator H).

How the code works today:

1. The hospital reports the dilation procedure’s CPT code and C1726 on the same UB-04 claim.
2. OPPS pays the procedure through its APC, and that rate already includes the catheter’s cost.
3. The C1726 line is packaged, so it carries no payment of its own.
4. CMS still reads the line’s charges, because device charge data feeds future APC rate-setting.

Followed through one esophageal dilation claim, the path looks like this.

Because the line is packaged, there is no C1726 dollar amount to chase. Payment questions belong to the procedure’s APC. The October 2026 OPPS Addendum B lists C1726 with status indicator N (packaged). CMS can change it in any quarterly update, so recheck each quarter before you build billing rules around it.

C1726 vs. C1713: Comparing related C-codes

C1726 and C1713 are both HCPCS Level II C-codes reported on hospital outpatient claims, but they describe very different devices. Both sit near the start of the C-code device range, so they turn up side by side in code lookups and chargemaster files.

The distinction matters because the two codes represent structurally different devices used in different procedures. Reporting one in place of the other is a descriptor mismatch, and auditors treat it as a coding error. Verify each code’s exact CMS descriptor against the AAPC HCPCS Level II code lookup or the official CMS HCPCS file before billing.

Payer requirements and prior authorization for C1726

Medicare OPPS claims that include HCPCS code C1726 follow standard institutional outpatient claim rules. The hospital must be enrolled as an OPPS provider. The claim goes on a UB-04 with the correct revenue code, and the device documentation stays on file.

Prior authorization requirements vary by payer and by the underlying procedure. Some Medicare Administrative Contractors (MACs) and commercial payers set coverage criteria for endoscopic or urologic dilation. Key payer requirements to verify in advance include:

• LCD/NCD compliance: the procedure must meet the medical necessity criteria in any applicable LCD or National Coverage Determination governing the underlying service
• Prior authorization: some commercial payers and Medicare Advantage plans require pre-authorization for the procedure, so verify with the specific payer before scheduling
• Current status indicator: confirm the C1726 status indicator in the OPPS Addendum B for the date of service
• Commercial contract terms: commercial payers may not follow OPPS packaging, so check whether your contract pays device lines separately
• Diagnosis code linkage: the ICD-10-CM diagnosis code on the claim must support medical necessity for the procedure and the device

Billing teams that track eligibility and prior authorization in software built for claims reduce the risk of a C1726 claim failing a payer’s coverage criteria. The check happens before the procedure date rather than after the denial arrives.

Documentation requirements for C1726 claims

The documentation for HCPCS code C1726 must establish three things. The catheter was used during a covered outpatient procedure, it matches the C1726 descriptor, and the procedure met medical necessity requirements.

Required documentation elements:

• Operative or procedure report: names the balloon catheter, the site dilated and the balloon size, since a generic “catheter used” won’t satisfy an auditor
• Device label or sticker: records the manufacturer, catalog number and lot number for the catheter
• Chargemaster entry: maps the catheter to C1726 and a supply revenue code, so the charge reaches the claim without manual entry
• Device invoice: kept on file to support the charge if an auditor asks
• ICD-10-CM diagnosis codes: the diagnosis must support medical necessity for the procedure and be consistent with the payer’s LCD or coverage policy

C1726 is a packaged line, so a modifier will not unlock separate payment for it. Run National Correct Coding Initiative (NCCI) checks on the procedure codes instead, where bundling edits can still cost you money.

ICD-10 diagnosis codes commonly paired with C1726

The diagnosis on a C1726 claim explains why the passage needed dilating. The codes below are common examples, not a complete list, so always code from the clinical record.

• K22.2 Esophageal obstruction: includes esophageal stricture treated with balloon dilation during EGD
• K83.1 Obstruction of bile duct: includes biliary stricture dilated during ERCP
• N13.5 Crossing vessel and stricture of ureter without hydronephrosis: a ureteral stricture treated during ureteroscopy

Pick the most specific code the documentation supports. A stricture with hydronephrosis, for example, takes a different code from N13.5.

Common denial reasons for HCPCS code C1726 and how to avoid them

C1726 problems cluster around a predictable set of errors. Because the line is packaged, most of them cost money through the procedure line or through bad cost data, not through the C1726 line itself. Strong denial management processes for device codes stop these patterns from recurring.

When a C1726 claim comes back with problems, start the clean claim review with the claim type and the procedure line. Those two checks resolve most issues without a full medical record review. For recurring edits on the procedure line, check the denial codes in medical billing tied to the edit. Then document the modifier rationale in the clinical record.

How Pabau keeps C1726 device details on the patient record

Device lines go wrong at the point of capture. The catheter sticker sits on a paper sheet, the operative note sits in another system, and the coder sees neither.

Pabau, the practice management platform we build, keeps treatment notes, consent forms and custom device fields on one patient record. Staff record the catheter type, size and lot number while the case is still open.

Pabau’s claims management tools sit on that same record. The coder builds the claim from the documented case, so the catheter line goes out with the procedure it belongs to.

Keep device details and claims on one record

Pabau brings treatment notes, custom device fields and claims onto one patient record. Your team documents the catheter once, so coders and auditors find it without chasing paper.

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Conclusion

C1726 will not change your OPPS payment for a dilation procedure, because the catheter’s cost is packaged into the procedure. Treat any guide that promises a separate pass-through payment for it as out of date. The code’s value now lies in accurate cost data and a clean audit trail.

Build the habit into your chargemaster and your coding checks. Confirm the status indicator each quarter, keep the catheter on the same claim as its procedure, and let a zero-paid line stand. Book a demo to see how Pabau keeps device details, notes and claims on one patient record.

Continue your research

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