HCPCS C9796 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Outpatient PPS Other Therapeutic Services and Supplies |
| Complexity Level | Moderate |
National average reimbursement for HCPCS C9796 by major payers:
$519.81
$N/A
$1,649.40
$N/A
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | C9796 | $945.00 | 1972770022 - OUTPATIENT EYE SURGERY CENTER | 721098835 - (LA) OUTPATIENT EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C9796 | $2738.00 | 1932204427 - NMC OPERATING COMPANY LLC, THE SPINE HOSPITAL OF LOUISIANA | 270059959 - (LA) NMC OPERATING COMPANY, LLC | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $1000.00 | 1306843826 - WEST CARROLL HEALTH SYSTEMS LLC, WEST CARROLL MEMORIAL HOSPITAL | 562300247 - WEST CARROLL HEALTH SYSTEMS L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $1623.00 | 1437482817 - ST MARTIN HOSPITAL, INC., ST MARTIN HOSPITAL | 264626264 - (LA) ST MARTIN HOSPITAL INC | LA | Critical Access Hospital (282NC0060X) |
United | C9796 | $2652.00 | 1376591941 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER | 726015227 | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $7446.00 | 1629076468 - CHRISTUS HEALTH SOUTHWESTERN LOUISIANA, CHRISTUS OCHSNER ST PATRICK HOSPITAL | 720411322 - (LA) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $962.00 | 1366506826 - AMERICAN LEGION HOSPITAL | 464958152 - (LA) ACADIA GENERAL HOSPITAL INC | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $1708.00 | 1215939210 - BRFHH MONROE LLC, OCHSNER LSU HEALTH MONROE | 800945173 - (LA) BRFHH MONROE LLC | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $1211.00 | 1134590912 - SLENT INVESTMENTS, LLC, SLENT SURGERY CENTER | 472307119 - (LA) SLENT INVESTMENTS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C9796 | $1643.00 | 1689676835 - NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT, NATCHITOCHES REGIONAL MEDICAL CENTER | 726013916 - (LA) NATCHITOCHES REGIONAL MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $1969.00 | 1225031495 - MONROE SURGICAL HOSPITAL, LLC | 721479756 - (LA) MONROE SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $1015.00 | 1073026639 - MID CITY SPECIALTY CENTER, LLC | 822996794 - (LA) MID CITY SPECIALTY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C9796 | $1102.00 | 1134300080 - METAIRIE LA ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER-METAIRIE | 205904604 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C9796 | $4828.00 | 1649488511 - TOURO INFIRMARY ANESTHESIA SERVICES | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | C9796 | $7085.00 | 1538174347 - LCMC HEALTH HOLDINGS INC, EAST JEFFERSON GENERAL HOSPITAL | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS C9796 vs. Other Other Therapeutic Services and Supplies Codes
The HCPCS C9796 code is part of the Outpatient PPS services used for Other Therapeutic Services and Supplies. 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 C9796 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 |
|---|---|---|
| C9796-HCPCS | Moderate | Repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis]) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C9796. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C9796 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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