C1815 — Prosthesis, urinary sphincter (implantable)
C1815 is a HCPCS Level II code for prosthesis, urinary sphincter (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 C1815 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
- 1 unit MAI 3 — Date of Service Edit: Clinical · Anatomic Consideration
- outpatient
- 1 unit 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 C1815
- Long descriptor
- Prosthesis, urinary sphincter (implantable)
- Short descriptor
- Pros, urinary sph, 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 C1815
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If C1815 is not quite right, the correct code is very often within a few positions of it.
- C1784Ocular device, intraoperative, detached retina
- C1785Pacemaker, dual chamber, rate-responsive (implantable)
- C1786Pacemaker, single chamber, rate-responsive (implantable)
- C1787Patient programmer, neurostimulator
- C1788Port, indwelling (implantable)
- C1789Prosthesis, breast (implantable)
- C1813Prosthesis, penile, inflatable
- C1814Retinal tamponade device, silicone oil
- 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
- C1821Interspinous process distraction device (implantable)
- C1822Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system
- C1823Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
Questions about C1815
What is HCPCS code C1815?
C1815 is a HCPCS Level II code for prosthesis, urinary sphincter (implantable). It sits in the Outpatient Prospective Payment System section.
Does Medicare cover C1815?
The CMS HCPCS file marks C1815 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.