HCPCS C1874 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Outpatient PPS Assorted Devices, Implants, and Systems |
| Complexity Level | High |
National average reimbursement for HCPCS C1874 by major payers:
$1,613.97
$52.00
$853.38
$818.23
HCPCS C1874 vs. Other Assorted Devices, Implants, and Systems Codes
The HCPCS C1874 code is part of the Outpatient PPS services used for Assorted Devices, Implants, and Systems. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS C1874 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| C1840-HCPCS | Moderate | Lens, intraocular (telescopic) |
| C1874-HCPCS | High | Stent, coated/covered, with delivery system |
| C1875-HCPCS | Moderate | Stent, coated/covered, without delivery system |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C1874. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C1874 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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