How To Use HCPCS Code C9081

HCPCS code C9081 describes the specific medical procedure known as Idecabtagene vicleucel. This code is used to identify the administration of up to 460 million autologous anti-bcma car-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose. It is important for medical coders to have a clear understanding of this code and its usage in order to accurately document and bill for this procedure.

1. What is HCPCS C9081?

HCPCS code C9081 is a specific code used to identify the administration of Idecabtagene vicleucel. This procedure involves the infusion of up to 460 million autologous anti-bcma car-positive viable T cells. It also includes the necessary leukapheresis and dose preparation procedures. The purpose of this therapy is to treat certain types of cancer, particularly multiple myeloma.

2. Official Description

The official description of HCPCS code C9081 is as follows: “Idecabtagene vicleucel, up to 460 million autologous anti-bcma car-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. Leukapheresis: The first step in the procedure involves the collection of the patient’s blood through a process called leukapheresis. This is done to obtain the autologous T cells that will be used in the therapy.
2. T Cell Modification: The collected T cells are then modified in the laboratory to express a chimeric antigen receptor (CAR) that targets the BCMA protein found on cancer cells.
3. Dose Preparation: Once the T cells have been modified, they are prepared in a therapeutic dose of up to 460 million cells.
4. Infusion: The prepared T cells are then infused back into the patient’s body, where they target and attack the cancer cells expressing the BCMA protein.

4. When to use HCPCS code C9081

HCPCS code C9081 should be used when documenting and billing for the administration of Idecabtagene vicleucel therapy. This therapy is specifically indicated for the treatment of multiple myeloma in patients who have not responded to other treatments or have relapsed after previous therapies. It is important to ensure that the patient meets the eligibility criteria for this therapy before using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9081, healthcare providers should ensure that the following documentation is included:

• Medical records supporting the diagnosis of multiple myeloma and the need for Idecabtagene vicleucel therapy
• Documentation of the leukapheresis procedure, including the collection of autologous T cells
• Documentation of the T cell modification process and dose preparation
• Documentation of the infusion of the prepared T cells

Providers should also follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure proper reimbursement for this procedure.

6. Historical Information and Code Maintenance

HCPCS code C9081 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has been in use since then and has not undergone any significant revisions or updates. However, it is important to note that this code is terminated as of December 31, 2021. Therefore, it should not be used for services rendered after this date.

7. Medicare and Insurance Coverage

HCPCS code C9081 is covered by Medicare and other insurance carriers. The pricing indicator code for this code is 57, which indicates that it is priced by carriers other than Medicare. The multiple pricing indicator code is A, which means that it is not applicable as HCPCS priced under one methodology. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific guidelines on billing and reimbursement for this procedure.

8. Examples

Here are five examples of when HCPCS code C9081 should be billed:

1. A patient with multiple myeloma who has not responded to previous treatments receives Idecabtagene vicleucel therapy.
2. A patient with relapsed multiple myeloma undergoes leukapheresis and receives a therapeutic dose of Idecabtagene vicleucel.
3. A healthcare provider administers Idecabtagene vicleucel therapy to a patient who meets the eligibility criteria for this treatment.
4. A patient with multiple myeloma receives leukapheresis, T cell modification, and infusion of Idecabtagene vicleucel as part of their treatment plan.
5. A healthcare provider documents and bills for the administration of Idecabtagene vicleucel therapy according to the specific guidelines set forth by Medicare or other insurance carriers.