C9901 Endo defect closure gi tract

Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for C9901

Payer coverage policies that name C9901

C9901 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaColonoscopy, Colorectal Cancer Screening, and Related Procedures (0516)covered if criteria are metAug 20, 2026payer document
AetnaUpper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738)covered if criteria are metOct 29, 2025payer document
AetnaUpper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738)listed, no stanceOct 29, 2025payer document

Medicaid fee-for-service

  • AZ: $4354.65 (asc), effective Oct 1, 2026
  • ND: $3889.65 (physician, facility), effective Aug 1, 2026
  • VT: $8253.65 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $4700.90 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.