HCPCS Code C1874: Stent, coated/covered, with delivery system

Key takeaways

HCPCS Code C1874 describes a stent that is coated or covered, supplied with its delivery system.

It is a Level II HCPCS C-code used for cardiovascular and vascular procedures.

C1874 is reported on UB-04 claims by hospitals billing outpatient services under Medicare’s Outpatient Prospective Payment System (OPPS).

The code carries pass-through device status under OPPS. Reimbursement is determined by the Ambulatory Payment Classification (APC) that CMS assigns.

Practice management software like Pabau helps outpatient facilities document and submit HCPCS device code claims accurately within a single billing workflow.

HCPCS Code C1874 is a Level II device code for a coated or covered stent supplied with its delivery system. It looks simple at first. In practice, however, the billing rules around it are not.

This reference covers the official descriptor, code attributes, 2026 fee schedule data, clinical use cases, billing guidelines, coverage criteria, and related HCPCS codes for C1874.

HCPCS Code C1874: Definition and official descriptor

HCPCS Code C1874 is the Level II code assigned to a stent that is coated or covered, supplied with its delivery system. Specifically, the code belongs to the C-series of HCPCS Level II codes that CMS maintains, covering devices, drugs, and supplies not captured by CPT codes alone.

Both short and long descriptors carry the same meaning. The stent and its deployment mechanism are billed together as a single unit. So, separating the stent from the delivery system and billing each independently is not correct under this code.

Code details: Attributes and OPPS status for HCPCS Code C1874

C-series codes like HCPCS Code C1874 are hospital outpatient-specific. They report devices provided during outpatient procedures and trigger pass-through payment review under CMS OPPS rules. In addition, several attributes determine how the claim is processed.

C-codes do not appear on the Medicare Physician Fee Schedule. So, billing staff who routinely work with CPT codes should note this difference. HCPCS Code C1874 is an institutional code, not a professional service code. Because of this, practices handling device billing need the same HIPAA compliance discipline in their documentation templates to avoid downstream claim errors.

C1874 fee schedule and Medicare reimbursement rates

Reimbursement for HCPCS Code C1874 under Medicare OPPS is tied to the Ambulatory Payment Classification (APC) assigned by CMS. The APC groups similar services and sets the payment rate for the combined procedure and any bundled device costs. In addition, for devices with active pass-through status, CMS may provide a separate pass-through payment on top of the APC rate.

Use CMS’s OPPS Addendum B page to retrieve the current year’s APC assignment and payment rates for C1874. The figures below are reference points only. So always check them against the current CMS OPPS Addendum B before submitting claims.

Pass-through status for C-codes is reviewed every year as part of CMS OPPS rulemaking. A code that carried pass-through payment in a prior year may lose that status in the current year. This happens once CMS decides the device cost is fully captured in the APC rate. So always check the current status in the Federal Register OPPS Final Rule before billing.

Clinical application: What procedures use HCPCS Code C1874?

C1874 is reported when a coated or covered stent with its delivery system is used during a hospital outpatient procedure. The coating or covering is the key feature that sets it apart. By contrast, bare metal stents are coded differently.

Drug-eluting stents are a primary clinical use case. For example, the AHA Coding Clinic has published specific guidance on drug-eluting stent billing under HCPCS that billers should consult for current direction.

Common procedures where HCPCS Code C1874 is reported include:

• Coronary artery stenting: drug-eluting or polymer-coated stents placed during percutaneous coronary intervention (PCI) in the outpatient setting
• Peripheral vascular intervention: covered stent placement in iliac, femoral, renal, or carotid arteries during outpatient procedures
• Biliary or gastrointestinal stenting: covered stents placed in bile ducts or the GI tract in select outpatient contexts
• Renal artery stenting: coated or covered stents used in outpatient renal artery revascularization procedures

The delivery system is included in the C1874 descriptor by design. During a stent procedure, the balloon catheter and deployment mechanism arrive pre-mounted with the stent. Therefore, billing the delivery system as a separate item when using C1874 counts as unbundling, which CMS and payers actively audit.

Billing guidelines for HCPCS Code C1874

Hospital outpatient billing staff submit HCPCS Code C1874 on a UB-04 claim form. Several rules govern correct submission. As a result, errors at any of these points can trigger a denial, a request for more documentation, or a post-payment audit recovery.

• Claim form: UB-04 (CMS-1450) only. HCPCS Code C1874 does not appear on CMS-1500 professional claims.
• Who reports: The hospital billing department, not the treating physician’s practice. The facility bears responsibility for device code accuracy.
• Revenue code pairing: Device codes are typically paired with an appropriate revenue code (commonly in the 027x series for medical/surgical supplies) on the outpatient claim.
• Units of service: Report one unit per stent with delivery system used. If multiple stents are placed in the same session, bill one unit per device.
• Modifier requirements: Review current OPPS guidelines for modifier use. Common modifiers include those for bilateral procedures and distinct procedural services, depending on the clinical scenario.
• Bundling rules: The delivery system is bundled into C1874. Do not separately bill catheter codes or balloon codes already included in the stent-delivery system package.
• Medical necessity: Tie the device code to the correct ICD-10-CM diagnosis code reflecting the vascular or cardiac condition requiring stent placement. Reviewers expect a clear, direct link between diagnosis and device.

For facilities managing high-volume cardiovascular outpatient services, claims management software that links device codes to procedure documentation reduces coding errors. It also supports clean claim submission. In turn, accurate medical forms and documentation at the point of care is where clean device code billing begins.

Pabau’s EHR integration workflows connect clinical notes directly to the billing queue, reducing errors where device codes are commonly dropped or miscoded.

Coverage and Medicare reimbursement criteria for C1874

Medicare covers a coated or covered stent with delivery system when it is medically necessary. Specifically, the condition must be an outpatient cardiovascular or vascular diagnosis. Coverage then follows the framework below.

• OPPS applicability: Coverage applies in the hospital outpatient setting. HCPCS Code C1874 is not reimbursable under the Medicare Physician Fee Schedule or the ASC fee schedule.
• Medical necessity: The procedure and device must be medically necessary as CMS defines. Any applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for the underlying condition also applies.
• Documentation requirements: The medical record must support the type of stent used (coated or covered), the procedure performed, and the clinical indication. A claim submitted without enough documentation to tell a coated stent apart from a bare metal stent is open to audit.
• LCD/NCD review: CMS and its Medicare Administrative Contractors (MACs) may publish LCDs covering coronary or peripheral vascular stenting. Review applicable LCDs before billing to confirm documentation and coverage criteria.
• Commercial payer variation: Coverage criteria for coated stents vary by commercial payer. Aetna, for example, maintains Clinical Policy Bulletin 0621 addressing drug-eluting stents. Verify payer-specific policies before submission. Never assume Medicare criteria apply to commercial plans without checking first.

Strong patient data security tools and audit-ready documentation practices are essential when billing high-value device codes. Likewise, the billing compliance checklist approach applies to institutional billing: every device claim should be traceable from clinical note to UB-04 line item.

Related HCPCS codes and crosswalk for stent billing

Selecting the correct HCPCS code for a stent procedure depends on whether the stent is coated, bare metal, covered, or part of a non-vascular system. Below, the table covers the most common codes near HCPCS Code C1874 in cardiovascular and vascular outpatient billing.

Use the AAPC HCPCS code lookup or the PGM HCPCS lookup tool to verify current descriptor and status before coding.

When reviewing related codes, note that coating or covering is the key difference between C1874 and C1876. Both codes include a delivery system, but C1876 covers a bare stent. By contrast, other related codes differ by device type altogether: a catheter, a pacemaker lead, or a balloon rather than a stent.

For broader context on procedural device billing codes in other specialties, the same pattern applies. Overall, bundling a device with its delivery mechanism stays consistent across HCPCS C-series codes.

How Pabau supports HCPCS billing compliance for outpatient facilities

Most billing errors on device codes like HCPCS Code C1874 originate upstream from claim submission. Any of the following creates the conditions for denial or a post-payment audit recovery:

• A clinical note that doesn’t specify the stent type.
• A charge capture process that drops the device code.
• A documentation workflow with no audit trail.

Pabau’s practice management software connects clinical documentation to billing workflows in a single platform.

Likewise, the same setup underpins GP practice management software for primary care and clinic management software for outpatient specialty groups.

For outpatient facilities billing cardiovascular device codes, the device type, procedure, and diagnosis can be documented at the point of care. That record then moves to the billing queue without manual re-entry.

• Integrated clinical records: Pabau’s clinical documentation tools capture procedure details at the encounter level, creating the audit trail that supports HCPCS device code claims.
• Claims management: The claims management software routes completed clinical documentation to billing staff with device codes flagged for review before submission.
• Compliance-ready records: Facilities working toward medical practice management software that supports HIPAA-compliant billing need documentation that is device-specific and payer-ready. Pabau’s records structure supports both.

Simplify HCPCS device code billing

Pabau connects clinical documentation to billing workflows, helping outpatient facilities submit HCPCS device code claims accurately and reduce coding errors at every step.

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Conclusion

HCPCS Code C1874 carries meaningful reimbursement stakes. It can add a separate payment on top of the APC rate, but only if the annual check happens before the claim goes out. However, skipping that step is the costliest mistake outpatient billing teams make with this code.

Treat the code as a routine checkpoint. Confirm the stent’s coated or covered status and keep the delivery system bundled into the claim. Then, recheck the pass-through status whenever CMS publishes a new OPPS Final Rule.

Pabau’s integrated billing and documentation workflows connect clinical documentation directly to device code accuracy, so outpatient facilities catch these details before a claim is denied. To see how Pabau handles HCPCS billing workflows, book a demo.

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Frequently asked questions

More FAQs on C1874 fee schedule and coverage