HCPCS Code C1749: Endoscope, retrograde imaging colonoscope device

Key takeaways

HCPCS Code C1749 describes an endoscope for retrograde imaging/illumination used as a colonoscope device (implantable) under HCPCS Level II

C1749 is billed in ambulatory surgical center (ASC) and hospital outpatient department (HOPD) settings under Medicare; payment status varies by setting and claim year

C1749’s pass-through payment status expired in CY2013; the device cost has been packaged into the associated procedure’s APC ever since

Practice management software like Pabau helps ASC and outpatient practices keep structured documentation for HCPCS device codes. This supports accurate records from code lookup through claim submission

HCPCS Code C1749 is a Level II code for an implantable endoscope used for retrograde imaging and illumination as a colonoscope device. Ambulatory surgical centers and hospital outpatient departments use it to capture separate reimbursement for the device used during a colonoscopy. Getting the code, the setting, and the documentation right are three separate tasks that all need to happen before the claim goes out.

This reference guide covers HCPCS Code C1749: its official description, classification, and Medicare payment status in ASC and HOPD settings. It also covers 2026 fee schedule data, documentation requirements, and a crosswalk of adjacent codes in the C1738-C1749 range. Billers at practices using digital documentation tools can also find guidance on how structured device records support accurate coding from lookup through claim submission.

HCPCS Code C1749: Definition and clinical description

HCPCS Code C1749 has a precise clinical descriptor that determines when it applies and when it does not. Submitting it for the wrong device type is one of the fastest routes to a denial or a post-payment audit.

The term “implantable” in the long description is clinically significant. It specifies the device characteristic that distinguishes C1749 from non-implantable endoscopic accessories. When documenting, the operative report and device invoice should both confirm the implantable nature of the colonoscope device used. According to the CMS, HCPCS Level II codes are maintained and updated annually. Coders should verify the current descriptor against the CMS HCPCS quarterly release files for the applicable claim date.

C1749 code classification and HCPCS category

C1749 sits at the upper end of the imaging supplies range within HCPCS Level II. Understanding where it falls in the broader code structure helps coders verify they are using the right code and not a similar adjacent one.

HCPCS Level II is administered by CMS and covers supplies, devices, and equipment not addressed by CPT codes. The C-code range is reserved for outpatient prospective payment system (OPPS) codes, including devices that may qualify for pass-through payment. C1749 falls within the C1738-C1749 block, which groups endoscopic and imaging-related device codes together. Coders using a general procedure code fee schedule reference should note that C-codes price differently than a professional-service code like HCPCS Code G0235.

• HCPCS Level II structure: Alphanumeric codes A0000-V9999, spanning DME codes like HCPCS Code E0205 and imaging supplies
• C-code range purpose: Hospital outpatient and ASC device and supply billing under CMS OPPS, the same system that prices HCPCS Code H0006
• C1749 category: Imaging supplies, endoscopic devices
• Code maintenance: CMS updates HCPCS Level II quarterly; annual updates take effect January 1

Medicare coverage and payment status for C1749

Medicare covers C1749 in ASC and hospital outpatient settings. The payment methodology depends on whether the code carries pass-through status at the time of the claim. This distinction directly affects how much a facility recovers.

Under CMS OPPS rules, certain new devices receive a temporary pass-through payment designation. This means the device is reimbursed separately from the procedure package, at cost plus a markup, typically for two to three years. Once that period expires, CMS folds the device cost into the Ambulatory Payment Classification (APC) package for the associated procedure. C1749’s pass-through status expired in CY2013, so its device cost has been packaged into the APC ever since. Coders can confirm current OPPS payment status for any C-code in the CMS OPPS Addendum B on the Hospital Outpatient PPS page. This beats relying on a prior year’s assumption.

ASC payment status for C1749

Ambulatory surgical centers operate under a separate payment system from hospital outpatient departments. The ASC payment indicator for C1749 determines whether the facility can bill the device separately or whether it is considered packaged into the colonoscopy service.

CMS publishes ASC payment indicators in Addendum AA and BB of the annual OPPS/ASC final rule. Because C1749’s pass-through status expired in CY2013, the device is typically packaged into the ASC colonoscopy payment rather than reimbursed separately. ASC billers coding for outpatient facility billing should still confirm the current payment indicator in the CMS ASC Addendum files. Packaging rules can differ slightly between the ASC and HOPD payment systems.

• Separately payable: C1749 reimbursed in addition to the ASC colonoscopy payment
• Packaged: Device cost included in the ASC colonoscopy service payment; no additional reimbursement
• Not covered / contractor discretion: Check MAC-specific policy for coverage conditions

Medicare Administrative Contractors (MACs) may also issue local coverage determinations or billing guidance that affects how C1749 claims are processed in specific geographic regions. Always cross-check with the relevant MAC’s published policies alongside the national CMS addenda. The same ASC-versus-HOPD payment distinction applies whether the billing facility is a GP practice or a physical therapy clinic reporting a device or supply code.

Hospital outpatient billing for C1749

Hospital outpatient departments bill C1749 under the OPPS, where Ambulatory Payment Classifications govern reimbursement. The billing workflow differs from ASC in several practical ways that affect claim construction.

In a HOPD setting, C1749 is reported on a UB-04 claim form alongside the colonoscopy procedure code. Pass-through status expired in CY2013. Because of that, the device payment is packaged into the APC for the associated colonoscopy procedure rather than paid on a separate line. Facilities using EHR and billing workflows can confirm the code still maps to the correct packaged status whenever CMS updates the annual OPPS final rule.

Revenue integrity teams should still audit C1749 claim lines periodically to confirm the device cost is packaged correctly rather than billed separately. A leftover separate-payment claim line can trigger a full denial or a recoupment request.

2026 Fee schedule rates for HCPCS Code C1749

Reimbursement for HCPCS Code C1749 in 2026 is not a single national figure. Rates vary by geographic locality and payment setting, and they depend on whether pass-through status applies for the claim date.

For pass-through device codes, CMS calculates payment based on the cost of the device as reported by the manufacturer or supplier. Adjustments are then applied through the OPPS payment rate-setting methodology. The CMS Fee Schedule tool covers professional services rather than OPPS device codes. HOPD and ASC billers should instead use the OPPS Addendum B and the ASC Addenda AA/BB as the primary sources for 2026 C1749 payment data. Third-party databases such as the AAPC Codify HCPCS lookup and PGM Billing lookup tool aggregate this data and provide a useful cross-reference. The CMS source files remain authoritative for claim submission purposes.

Geographic variation comes from the wage index applied to the labor-related portion of device payments. A facility in a high-wage metropolitan area will receive a different effective rate than a rural hospital even for the same device code. Always pull locality-specific rates from the CMS OPPS final rule addenda or verify with your MAC before building a reimbursement estimate.

Billing requirements and documentation for C1749

Submitting C1749 without adequate documentation is the fastest path to a denial or a post-payment recovery request. Three documentation elements are non-negotiable.

• Operative report: Must confirm the specific device used, including its implantable nature and lot number. It should also confirm retrograde imaging/illumination as the device’s mechanism during the procedure.
• Device invoice or implant log: Facilities should retain the manufacturer invoice or the implant tracking log. Either document should show that the unit dispensed matches the HCPCS descriptor for C1749.
• Procedure linkage: C1749 must appear on the same claim as the colonoscopy procedure code; orphaned device lines without an associated procedure code are routinely denied

Coders at practices using integrated practice management software can keep the operative report, device invoice, and procedure code linked in one patient record. That makes the documentation behind a C1749 claim easy to retrieve during coding or an audit. This beats reconstructing the paper trail manually after the fact, especially in high-volume facilities processing multiple colonoscopy cases per day.

Modifier requirements for C1749 depend on the specific payer and MAC. Some contractors require modifiers to indicate the device was used in a specific surgical approach or anatomical location. Check MAC-specific billing guidance and payer contracts before finalizing the claim template for this code. Practices building out their digital clinical documentation workflows can capture device details at point of care, reducing transcription errors when the coder builds the claim.

Related codes in the C1738-C1749 imaging supplies range

The C1738-C1749 block groups imaging supply and endoscopic device codes that share a similar billing context. Choosing the wrong code within this range is a common audit finding because the devices appear clinically similar but have distinct HCPCS descriptors.

C1738 and C1749 sit in the same code range but describe unrelated device types. C1738 covers a powered, single-use endoscopic ultrasound-guided biopsy device, while C1749 covers an implantable colonoscope device used for retrograde imaging and illumination. Confirming the device type against the invoice and operative report before code selection prevents cross-coding between the two. Billers cross-referencing this range can also consult CPT Code 45378. It shows how the procedure code and the device code work together on the same claim.

Documenting the specific device model, its implantable classification, and its anatomical application in the operative note is the most reliable way to defend code selection. This matters most during a payer audit. The device manufacturer’s product classification documentation can also serve as supporting evidence if a payer challenges the code.

How Pabau supports documentation for outpatient HCPCS billing

Reference databases for HCPCS codes like C1749 solve only part of the billing problem. Coders look up the code, confirm the descriptor, and then manually enter it into their billing system. Every manual transfer is a point where errors occur.

Practice management software like Pabau keeps clinical documentation and patient records in one system instead of scattered across paper charts and spreadsheets. This matters most for ASC and outpatient facilities handling device-intensive colonoscopy cases. The operative report, the device invoice, and the procedure note all stay linked to the same patient record. A coder or an auditor can then pull the full documentation trail for any C1749 case without hunting through separate files. Practices that want tighter documentation can connect clinical notes directly to the patient record. They can also use CPT Code 00812 on the Pabau platform for related billing context.

For facilities processing high volumes of endoscopy cases, organized documentation is a practical necessity, not an optional extra. A missing operative report or device invoice on a single C1749 case can trigger a full denial or a post-payment audit. Resolving that costs far more than preventing it would have.

Keep device documentation organized for C1749 claims

Pabau's digital forms and clinical notes keep the operative report, device invoice, and procedure code together in one patient record. ASC and outpatient teams can then retrieve complete documentation for any HCPCS device claim. See how it works for your practice.

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Conclusion

C1749’s biggest billing risk is treating last year’s payment status as current fact. Pass-through expired in CY2013, so the device cost belongs in the APC, not on a separate claim line. Coders who confirm that against the live CMS OPPS Addendum B before submission avoid the error that causes most C1749 denials.

Pabau’s practice management software helps outpatient practices keep device documentation, operative reports, and procedure codes linked in one patient record for audit-ready billing. To see how it works for your team, book a demo.

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