How To Use HCPCS Code C9454

HCPCS code C9454 describes the injection of pasireotide long acting, 1 mg. This code is used to identify the administration of this specific medication in a long-acting form. In this article, we will explore the details of HCPCS code C9454, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS C9454?

HCPCS code C9454 is used to identify the injection of pasireotide long acting, 1 mg. This medication is administered in a long-acting form, providing sustained release of the active ingredient over a period of time. It is important to use this specific HCPCS code when reporting the administration of pasireotide long acting to ensure accurate billing and reimbursement.

2. Official Description

The official description of HCPCS code C9454 is “Injection, pasireotide long acting, 1 mg.” This description accurately reflects the nature of the service being provided, which is the administration of pasireotide long acting in an injectable form. The short description for this code is “Parenteral supp not othrws c,” indicating that this code is used for parenteral supplementation that does not fall under any other category.

3. Procedure

1. Prepare the pasireotide long acting injection according to the manufacturer’s instructions.
2. Select an appropriate injection site, ensuring proper aseptic technique.
3. Administer the pasireotide long acting injection using the appropriate needle and syringe.
4. Monitor the patient for any adverse reactions or complications following the injection.

It is important for healthcare providers to follow standard protocols and guidelines for administering injections to ensure patient safety and the effectiveness of the medication.

4. When to use HCPCS code C9454

HCPCS code C9454 should be used when administering pasireotide long acting, 1 mg. This code is specific to the long-acting form of pasireotide and should not be used for other formulations or dosages. It is important to review the patient’s medical records and documentation to confirm the use of pasireotide long acting and ensure that it meets the criteria for billing with this specific HCPCS code.

5. Billing Guidelines and Documentation Requirements

When billing for the administration of pasireotide long acting using HCPCS code C9454, healthcare providers should ensure that the necessary documentation is in place. This may include the following:

• Documentation of the patient’s medical condition or diagnosis that justifies the use of pasireotide long acting.
• Documentation of the dosage and administration of pasireotide long acting, including the date and time of the injection.
• Documentation of any adverse reactions or complications that occurred during or after the administration of pasireotide long acting.

By providing accurate and detailed documentation, healthcare providers can support the medical necessity of the service and facilitate proper billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9454 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. This code has a termination date of December 31, 2015, indicating that it is no longer in use. The termination of this code means that it is no longer valid for billing purposes and should not be used for reporting the administration of pasireotide long acting.

7. Medicare and Insurance Coverage

HCPCS code C9454 may have specific coverage instructions that apply, as indicated by the coverage code D. It is important for healthcare providers to review the coverage guidelines and requirements of Medicare and other insurance carriers to ensure proper reimbursement for the administration of pasireotide long acting. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code C9454 should be billed:

1. A patient with a diagnosis of acromegaly receives an injection of pasireotide long acting, 1 mg, as part of their treatment plan.
2. A patient with Cushing’s disease undergoes an injection of pasireotide long acting, 1 mg, to manage their symptoms.
3. A patient with neuroendocrine tumors receives an injection of pasireotide long acting, 1 mg, to help control tumor growth.
4. A patient with refractory diarrhea associated with carcinoid syndrome receives an injection of pasireotide long acting, 1 mg, to alleviate their symptoms.
5. A patient with a pituitary adenoma undergoes an injection of pasireotide long acting, 1 mg, as part of their preoperative preparation.