HCPCS Code C1758: Catheter, ureteral billing guide

Key takeaways

HCPCS Code C1758 is the Level II C-code describing a ureteral catheter, used only in hospital outpatient departments and ambulatory surgery centers (ASCs).

C1758 is an active outpatient PPS code maintained by CMS. It cannot be billed in a physician office or on a DME claim.

Every claim needs medical necessity documentation, a physician order, and a supporting ICD-10 diagnosis code. Local coverage determinations may add more.

A packaged ASC payment indicator produces a zero-paid line rather than a denial, so C1758 revenue can disappear without an alert.

Practice management software like Pabau submits and tracks each claim, and keeps the order and procedure note on the patient record.

What C1758 is and how it is classified

HCPCS Code C1758 is a HCPCS Level II C-code with the official descriptor “Catheter, ureteral.” It reports the ureteral catheter used during a urological procedure in a hospital outpatient department or an ambulatory surgery center.

The Centers for Medicare and Medicaid Services (CMS) maintains C1758 as part of the Outpatient Prospective Payment System (OPPS) code set. C-codes apply only to hospital outpatient departments (HOPDs) and ambulatory surgery centers. They are not valid for physician office billing or durable medical equipment (DME) claims.

Two things decide whether a C1758 line gets paid. The setting has to be institutional, and the code’s ASC payment indicator has to still be separately payable that year. The second one is the trap, because a packaging change pays zero without generating a denial.

Submitting C1758 on a physician-office claim triggers an automatic denial, because the setting restriction is built into payer edits.

C1758 code details at a glance

The table below summarizes the administrative attributes coders need before submitting a C1758 claim.

Code status can change between OPPS rule cycles. Verify C1758 against the current CMS HCPCS master file before submitting, especially at the start of a calendar year.

Where is C1758 used?

C1758 can be billed in a hospital outpatient department or an ambulatory surgery center, and nowhere else. CMS created the C-code category specifically for the OPPS environment, so the setting restriction is part of the code’s definition.

• Hospital outpatient department (HOPD): The hospital bills on a UB-04 claim. C1758 sits alongside the revenue code to identify the catheter used during the procedure.
• Ambulatory surgery center (ASC): The ASC reports C1758 on its facility claim. CMS assigns each C-code an ASC payment indicator that decides whether the supply is separately reimbursable or packaged into the procedure payment.

Confirm the ASC payment indicator for C1758 against the current CMS OPPS Addendum B. Indicator values can change between annual rule updates.

A value such as “N” typically means the item is packaged, with no separate payment. Indicators like “J1” or “J2” reflect different payment methodologies. Submitting C1758 without checking the current indicator is a common source of zero-payment remittances.

Office-based urology and pelvic health practices bill the procedure with CPT codes instead of C-codes. Payer systems apply the setting edit automatically, so there is no manual override.

Medicare coverage and C1758 fee schedule rates

Medicare Part B is the primary federal payer for outpatient supplies billed under HCPCS Code C1758. Payment rates for C-codes in the OPPS environment are governed by the Ambulatory Payment Classification (APC) system rather than the Physician Fee Schedule.

Coverage for C1758 is not blanket. Medicare Administrative Contractors (MACs) administer claims regionally, and local coverage determinations (LCDs) may impose additional requirements or restrict coverage to specific diagnosis codes. A claim that is payable under one MAC jurisdiction may require additional documentation under another.

2026 C1758 fee schedule update

CMS updates OPPS payment rates each January through the annual OPPS final rule. For 2026 rates, check the OPPS Addendum B file published alongside the Calendar Year 2026 final rule.

Addendum B lists the national unadjusted payment rate and the status indicator for each code. Your actual payment is adjusted by the wage index for your locality.

This guide does not publish a static rate, because the figures change every year. Download the OPPS Addendum B file for the current calendar year and look up C1758 directly.

Rate lookup stays a manual step. Practice management software like Pabau tracks each submitted claim through to payment, with the physician order and procedure note held on the patient record.

ICD-10 diagnosis codes used with C1758

Every claim for C1758 must include at least one ICD-10 diagnosis code that establishes medical necessity for the ureteral catheter. Without a supporting diagnosis, payers will deny the claim as lacking medical necessity documentation.

The ICD-10 codes most commonly paired with C1758 cover urological conditions that require ureteral catheterization. The table below lists frequently used diagnoses. Always verify against your MAC’s applicable LCD before submitting, since coverage lists differ by jurisdiction.

This crosswalk is not exhaustive. MAC LCDs govern which diagnoses satisfy medical necessity for ureteral catheter billing, and a code that works in one jurisdiction may not in another.

Documentation requirements for billing C1758

Documentation deficiencies are the leading cause of C1758 claim denials that survive initial submission. Payers expect to see a clear chain from clinical decision to supply usage, and auditors look for this chain when reviewing records.

The following checklist reflects standard Medicare supply documentation requirements. Requirements vary by payer and MAC jurisdiction. Confirm against the applicable LCD before submitting.

• Physician order: A signed order documenting the medical need for a ureteral catheter, including the indication, date, and ordering provider’s credentials.
• Medical necessity statement: Clinical notes establishing why the procedure requiring C1758 was medically necessary, linked to a supported ICD-10 diagnosis code.
• Procedure note: Operative or procedure report confirming the ureteral catheter was used during the encounter, with the date of service matching the claim.
• Diagnosis linkage on the claim: At least one ICD-10 code on the claim that crosswalks to the ureteral catheter indication. The diagnosis must appear on the claim form in a position that links to C1758.
• Setting confirmation: Documentation confirming the service occurred in an HOPD or ASC, not a physician office or inpatient facility.
• Payer-specific requirements: Some MACs require a Certificate of Medical Necessity (CMN) or prior authorization for specific catheter supplies. Check the applicable LCD for jurisdiction-specific rules.

Digital medical forms capture physician orders and procedure notes at the point of care. A timestamped order and note give you an audit-ready trail without extra administrative work.

Related HCPCS codes for ureteral catheters

C1758 is one of several HCPCS codes covering catheter supplies in outpatient urology. Confusing a ureteral catheter with a urethral or intermittent catheter is a common coding error. It usually ends in a downcode or a denial.

The intermittent urinary catheter codes (A4351, A4352, A4353) belong to the DME benefit and use a different billing pathway. Billing one on an HOPD claim gets the line rejected for the wrong benefit category.

C1729 describes a drainage catheter, and it applies when the scenario involves drainage rather than ureteral access. In the same C-code family, C1732 covers an electrophysiology catheter and C1815 covers a urinary sphincter prosthesis.

C1758 vs. CPT codes: what is the difference?

C1758 describes the supply, and a CPT code describes the procedure. The two are not interchangeable, even when the same physical catheter is involved.

An HOPD billing team often submits both codes on the same UB-04 claim. The CPT code covers the urological procedure, such as ureteroscopy, and C1758 covers the catheter. Whether C1758 pays separately or gets packaged into the procedure’s APC depends on the current ASC payment indicator.

For descriptor lookups, the AAPC HCPCS lookup is a quick reference, and the AMA publishes the matching CPT descriptors. The two systems run in parallel on the same claim.

Practices that bill both professional and facility claims run two code sets side by side. Practice management software that handles both claim types in one workflow cuts the risk of a mismatch.

Common C1758 billing errors and how to avoid them

C1758 denials cluster around a short list of mistakes. Each one is easy to catch before submission, and each one is expensive to unpick afterwards. Most of them are basic medical billing hygiene rather than urology-specific coding.

• Wrong setting on the claim: Submitting C1758 on a CMS-1500 professional claim, or attaching it to a physician office encounter. C-codes are institution-only, so the line has to come from the facility on a UB-04.
• Missing ICD-10 linkage: Submitting C1758 without a supporting diagnosis code, or listing it in a position that does not link to the supply line. Every supply code needs a diagnosis pointer.
• Using the intermittent catheter A-codes instead: A4351 and A4352 are for DME claims. Billing these on an HOPD claim flags the claim for rejection. Know the supply type before selecting the code.
• Ignoring ASC payment indicator changes: When CMS packages a C-code that used to pay separately, the line returns at zero with no denial code. Checking the indicator annually prevents that silent revenue loss.
• Insufficient procedure note detail: The note has to name the supply. A note signed after the claim went out gives payers grounds to deny.
• Not verifying MAC jurisdiction rules: Coverage for C1758 can differ between Novitas, Noridian, CGS, and other MACs. A claim that passes under one MAC’s LCD may fail under another. Confirm the applicable LCD before billing in a new geography.

EHR integrations that flag a claim line with no diagnosis pointer catch these errors before submission. Reworking a denied claim costs far more staff time than checking it once. That is the case for tightening revenue cycle management.

How claims tracking helps you spot unpaid C1758 lines

Most outpatient billing teams track C1758 in two places at once. The order and the procedure note sit in the clinical record, while claim status lives in a spreadsheet or a payer portal. Reconciling the two is manual work.

Pabau’s claims management software keeps both on the same patient record. Digital forms capture the physician order and the procedure note at the point of care. Pabau then submits the claim and tracks it through to payment.

Coding decisions stay with your coders. Pabau does not pick the code or set the diagnosis pointer. What it changes is the follow-up, so you can see which C1758 lines were paid, denied, or returned at zero.

That works the same way for a hospital outpatient urology service and for a standalone men’s health practice. Catching a zero-paid line this quarter beats finding it a year later.

Track every supply claim through to payment

Pabau keeps the physician order and procedure note on the patient record, then submits and tracks each claim. You can see what was paid, denied, or zero-paid in one place.

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Conclusion

Getting C1758 right is mostly a matter of discipline before the claim goes out. Confirm the setting, check the ASC payment indicator for the current year, and get the order and procedure note signed first.

The trade-off worth remembering is that C1758 can stop paying without ever being denied. Denial reports will not show it. A quarterly look at zero-paid lines will, and that habit is worth more than any single coding rule above.

Pabau keeps the documentation and the claim status in one place, so those zero-paid lines surface early. Book a demo to see how outpatient and ASC billing runs in Pabau.

Continue your research

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Working out where the DME benefit starts? E0153 shows how a DME supply claim differs from an outpatient facility claim.

Frequently asked questions