HCPCS code C1765: Adhesion barrier billing and fee schedule guide

Key takeaways

HCPCS code C1765 describes an adhesion barrier: a bioresorbable surgical supply placed during abdominal, pelvic, or orthopedic procedures to prevent post-operative scar tissue.

C1765 is an HCPCS Level II C-series code billed exclusively by hospital outpatient facilities under the Medicare OPPS, not by the treating physician.

Medicare reimburses C1765 through the Hospital Outpatient Prospective Payment System (OPPS); rates vary by geography and are updated annually in the CMS OPPS final rule.

Practice management software like Pabau helps the surgeon’s own practice keep the consult notes and consent records that support their separate professional-fee claim for the same procedure.

HCPCS code C1765 is a Level II C-series code with the official short description “Adhesion barrier.” Hospital outpatient facilities bill it under Medicare’s Hospital Outpatient Prospective Payment System (OPPS) for a bioresorbable surgical supply placed during abdominal, pelvic, or orthopedic procedures to prevent post-operative scar tissue.

This guide covers the code’s clinical use, Medicare fee schedule, billing requirements, modifiers, related codes, and the most common documentation errors. Most denials trace back to billing from the wrong side, a missing modifier, or an outdated payment rate.

Verify current rates directly with CMS’s HCPCS program page before submitting claims, since OPPS rates update each calendar year.

HCPCS code C1765: Definition and code details

HCPCS code C1765 carries the official short description “Adhesion barrier.” It belongs to the C-series of HCPCS Level II, a subset of temporary codes that practice billing teams commonly encounter when coding for hospital outpatient implantable devices and surgical supplies.

C-series codes are maintained by CMS to support OPPS payment for implantable devices and supplies that lack a permanent HCPCS or CPT designation. C1765 is one of these temporary codes, billed exclusively by the hospital facility.

The surgeon’s own professional fee for the same procedure is billed separately under CPT. Practice management software like Pabau helps the surgical practice keep the consult notes, consent forms, and referral records that support that claim, so nothing is missing when it’s time to bill the visit.

Clinical use: When is C1765 reported?

An adhesion barrier is a bioresorbable material placed directly at a surgical site to reduce post-operative scar tissue formation.

Post-operative adhesions are a well-documented complication following abdominal, pelvic, and certain orthopedic procedures, and adhesion barriers are designed to create a temporary physical separation between tissue surfaces while healing occurs.

Post-surgical rehab for these cases is often coordinated through practices using physical therapy EMR software.

• Abdominal surgery (open or laparoscopic): bowel resection, colectomy, appendectomy, hernia repair with risk of peritoneal adhesions
• Pelvic / gynecologic surgery: hysterectomy, myomectomy, endometriosis excision, tubal procedures
• Colorectal procedures: low anterior resection, abdominoperineal resection
• Orthopedic procedures: tendon repair and certain joint surgeries where adhesion formation may limit function

Practices that specialize in gynecologic surgery, such as those running on OB-GYN EMR software, frequently refer patients for these procedures and coordinate documentation with the hospital’s coding team.

C1765 is reported by the hospital outpatient facility at the time the adhesion barrier product is placed during the qualifying surgical procedure.

The operative note must document the specific product used and the anatomical site of placement. Thorough documentation at the point of care is the single most effective way to prevent downstream claim denials for supply codes like C1765.

Orthopedic cases are often confirmed with a standard workup, such as a hip examination, before the surgical team schedules the procedure. Anesthesia for these cases is billed separately under CPT code 00450, distinct from any facility-side device charge.

C1765 OPPS payment and Medicare reimbursement

Medicare reimburses HCPCS code C1765 through the Hospital Outpatient Prospective Payment System. Under OPPS, CMS assigns each covered service or supply to an Ambulatory Payment Classification (APC) group.

The payment rate for C1765 reflects the APC-level packaged or separately payable amount, depending on how CMS classifies the code in the applicable OPPS final rule year.

Geographic payment adjustments apply through the hospital wage index, so the Medicare payment for C1765 differs by facility location. Private payer contracted rates are negotiated separately and can differ materially from the Medicare OPPS rate.

Always verify the rate in effect for your facility’s region using CMS’s Hospital Outpatient PPS regulations and notices page, which links to the current OPPS Addendum A and B files. Good billing compliance practices include documenting the rate source each time a HCPCS supply code is added to the CDM.

2026 fee schedule for HCPCS code C1765

CMS updates OPPS payment rates annually through the OPPS/ASC final rule, typically published in November for the following calendar year. The authoritative source for the 2026 payment rate for C1765 is CMS OPPS Addendum B, which lists all separately payable OPPS codes with their national average payment amounts.

Third-party aggregator sites may show estimated or historical rates that do not reflect the current CMS OPPS Addendum B figures. Always pull directly from the CMS source. Use the AAPC HCPCS code lookup to cross-reference the code description, but for payment amounts, the CMS Addendum B is the only authoritative source.

Outpatient facilities managing multiple HCPCS device codes benefit from EHR integration workflows that keep CDM entries synchronized with annual rate updates.

Billing guidelines for HCPCS code C1765

C-series HCPCS codes are facility-side codes. The hospital outpatient facility reports C1765 on a UB-04 claim form (or its electronic equivalent, the 837I transaction). The physician performing the surgery does NOT separately bill C1765 on a CMS-1500 claim. Conflating these two claim types is one of the most frequent causes of denial for adhesion barrier charges.

Applicable modifiers

Modifiers for HCPCS code C1765 follow standard OPPS modifier rules. Modifier requirements can vary by payer and should be verified against individual payer policies and current CMS transmittals.

Beyond these, standard OPPS modifiers for bilateral procedures or multiple units may apply depending on clinical circumstances. Check with your MAC (Medicare Administrative Contractor) or your facility’s compliance team for the most current modifier guidance.

Maintaining accurate modifier logic within your digital documentation workflow reduces the risk of submitting a claim without a required modifier.

Related HCPCS codes and crosswalk

Several other HCPCS C-series codes cover related surgical supplies and implantable devices. Knowing the key differences helps coders select the most specific code and avoids upcoding or undercoding for adhesion barrier products.

If the adhesion barrier product used during the procedure has its own distinct HCPCS code assigned by CMS, report that specific code rather than C1765. Use C1765 when the product is an adhesion barrier and no more specific code applies.

Review the current CMS HCPCS file annually, since new product-specific codes are added each year. Coders managing a broader mix of C-series codes may also need HCPCS code C1730 for electrophysiology catheter claims, a distinct billing scenario.

Outpatient coding teams that manage multiple surgical supply codes benefit from integrated practice management platforms that centralize code library updates.

How to document and code C1765 correctly

Getting the documentation right before claim submission is faster than correcting a denial after the fact. These steps apply to the standard OPPS workflow for C1765.

1. Operative note: The surgeon documents the specific adhesion barrier product (brand name, lot number, and anatomical site of placement) in the operative report at the time of surgery.
2. Charge capture: The facility coding or charge capture team reviews the operative note and posts C1765 to the encounter. Confirm the product is classified as an adhesion barrier, not a wound dressing or fixation device.
3. Modifier review: Determine whether an FB, FC, or GK modifier applies based on acquisition cost and ABN status.
4. Place of service / bill type: Confirm the claim is submitted on a UB-04 (837I) with the hospital outpatient facility bill type (13X for outpatient surgery). Never submit C1765 on a CMS-1500.
5. Claim submission and audit trail: Retain the operative note, product invoice, and lot number documentation together for the claim file. This package supports an audit or reopening request if the claim is denied or underpaid.

Facilities using structured billing compliance checklists as part of their pre-bill review process catch most of these errors before submission rather than after. A secure data workflow that links operative documentation to the billing record also makes audit responses faster.

Common billing errors with C1765

Denial patterns for adhesion barrier claims tend to cluster around a short list of avoidable errors. Recognizing them before submission is more efficient than managing appeals.

• Wrong claim form: Submitting C1765 on a CMS-1500 (professional) instead of a UB-04 (institutional). C-series codes are facility codes and are not recognized on professional claims.
• Incorrect place of service: C1765 is used exclusively in hospital outpatient settings. Reporting it from an ambulatory surgery center that does not fall under OPPS rules can result in denial or recoupment.
• Missing modifier when required: Omitting a modifier (FB, FC, or GK) when the clinical or contractual circumstances require it results in processing delays or denial.
• Using an outdated fee schedule rate: Billing the prior year’s OPPS rate creates underpayment or triggers claim adjustments. Update CDM entries each January.
• Insufficient operative documentation: A generic reference to “adhesion barrier placed” without specifying the product name, lot number, and anatomical site may not support a separately payable device charge upon audit.
• No local coverage determination (LCD) review: Some Medicare Administrative Contractors publish LCDs that affect coverage for adhesion barrier products. Failure to check for applicable LCDs before billing can result in denial.

Periodic internal coding audits that include a sample of C1765 claims help surface these patterns before they accumulate into underpayment or compliance risk. Reviewing denial trend reports by reason code on a regular cadence catches C-series coding issues within days rather than weeks.

How Pabau supports practices that refer patients for C1765 procedures

The hospital facility bills C1765 directly to Medicare under OPPS — that side of the claim never touches the referring practice’s system. But the surgeon or specialist who performs the procedure still bills their own professional fee separately under CPT, and that claim depends on the same operative documentation, consent forms, and referral notes the practice already collects.

Practice management software like Pabau’s claims management tools keep those records — consult notes, signed consent forms, and referral correspondence — attached to the patient’s chart, so the practice’s own billing team has everything it needs to submit a clean professional-fee claim without chasing down paperwork after the fact.

For practices juggling referrals to multiple facilities, having consent and documentation centralized in one record cuts down on the back-and-forth when a claim is questioned or a facility requests supporting notes.

Keep referral documentation and billing organized

Pabau's claims management software helps private practices keep consult notes, consent forms, and referral records organized and attached to the patient record, so the practice's own claims go out clean the first time.

Book a demo

Conclusion

C1765 claims fail for avoidable reasons: the wrong claim form, a missing modifier, an outdated CDM rate. Catching them before submission takes documentation discipline and a process that runs the same way every time.

Get the operative note right at the point of care, keep the CDM rate current every January, and confirm the bill type before the claim leaves the building. Do that consistently, and C1765 stops showing up on the denial report.

The same discipline applies on the practice side, where the professional-fee claim for the same procedure runs through a different system entirely. Book a demo to see how Pabau keeps a referring practice’s consult notes, consents, and referral records organized for clean claims.

Continue your research

Coding a different implantable device? HCPCS code L0457 covers billing and coverage for a flexible TLSO, another facility-side supply code.

Handling a DME claim instead? HCPCS code A4459 walks through billing for a transanal irrigation system.

Need an ICD-10 code for a musculoskeletal deformity? ICD-10 code M95.8 covers other specified acquired deformities.

Planning a patient’s post-surgical discharge? This discharge planning checklist gives outpatient teams a structured handoff after a qualifying procedure.

Want to tighten up claim documentation generally? Medical decision making explains how documentation depth affects clinical coding and reimbursement.

Frequently asked questions

Billing, modifiers, and coding for HCPCS code C1765