C1789 — Prosthesis, breast (implantable)
C1789 is a HCPCS Level II code for prosthesis, breast (implantable). It belongs to the Outpatient Prospective Payment System section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of C1789 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 2 units MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
- outpatient
- 2 units MAI 3 — Date of Service Edit: Clinical · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for C1789
- Long descriptor
- Prosthesis, breast (implantable)
- Short descriptor
- Prosthesis, breast, imp
- Added
- April 1, 2001
- BETOS
- D1A
- Pricing indicator
- 53 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Statute.
Codes adjacent to C1789
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If C1789 is not quite right, the correct code is very often within a few positions of it.
- C1781Mesh (implantable)
- C1782Morcellator
- C1783Ocular implant, aqueous drainage assist device
- C1784Ocular device, intraoperative, detached retina
- C1785Pacemaker, dual chamber, rate-responsive (implantable)
- C1786Pacemaker, single chamber, rate-responsive (implantable)
- C1787Patient programmer, neurostimulator
- C1788Port, indwelling (implantable)
- C1813Prosthesis, penile, inflatable
- C1814Retinal tamponade device, silicone oil
- C1815Prosthesis, urinary sphincter (implantable)
- C1816Receiver and/or transmitter, neurostimulator (implantable)
- C1817Septal defect implant system, intracardiac
- C1818Integrated keratoprosthesis
- C1819Surgical tissue localization and excision device (implantable)
- C1820Generator, neurostimulator (implantable), with rechargeable battery and charging system
Questions about C1789
What is HCPCS code C1789?
C1789 is a HCPCS Level II code for prosthesis, breast (implantable). It sits in the Outpatient Prospective Payment System section.
Does Medicare cover C1789?
The CMS HCPCS file marks C1789 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.