How To Use HCPCS Code C9463

HCPCS code C9463 describes an injection of aprepitant, with a dosage of 1 mg. This code is used to identify the administration of aprepitant, a medication commonly used to prevent nausea and vomiting caused by chemotherapy or certain surgical procedures. In this article, we will explore the details of HCPCS code C9463, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS C9463?

HCPCS code C9463 is a specific code used to identify the injection of aprepitant, with a dosage of 1 mg. It is important to note that this code is specific to the administration of aprepitant and should not be used for any other medications or procedures.

2. Official Description

The official description of HCPCS code C9463 is “Injection, aprepitant, 1 mg.” This description accurately represents the purpose and dosage of the medication being administered.

3. Procedure

1. Prepare the aprepitant injection according to the manufacturer’s instructions.
2. Verify the patient’s identity and confirm the appropriateness of the medication for their condition.
3. Select an appropriate injection site, ensuring proper aseptic technique.
4. Administer the aprepitant injection using the appropriate needle and syringe.
5. Dispose of the used needle and syringe in a sharps container.
6. Document the administration of the aprepitant injection in the patient’s medical record.

4. When to use HCPCS code C9463

HCPCS code C9463 should be used when administering aprepitant, specifically at a dosage of 1 mg. It is important to ensure that the patient meets the criteria for receiving aprepitant and that the medication is being administered for its intended purpose of preventing nausea and vomiting caused by chemotherapy or certain surgical procedures.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9463, healthcare providers should ensure that the following documentation is included:

• Documentation of the patient’s eligibility for aprepitant administration.
• Documentation of the dosage and administration of the medication.
• Documentation of the medical necessity for the administration of aprepitant.

Providers should also follow the appropriate billing guidelines and submit the necessary claims and supporting documentation to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9463 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 1996. This code has not undergone any maintenance actions, as indicated by the action code N, which means no maintenance for this code. It is important to note that HCPCS code C9463 was terminated on December 31, 2018, and is no longer in use.

7. Medicare and Insurance Coverage

HCPCS code C9463 may be eligible for coverage by Medicare and other insurance providers. 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, which means it is not applicable as HCPCS priced under one methodology. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific guidance on coverage and reimbursement for HCPCS code C9463.

8. Examples

Here are five examples of scenarios where HCPCS code C9463 may be billed:

1. A patient undergoing chemotherapy receives an aprepitant injection to prevent nausea and vomiting.
2. A patient undergoing a surgical procedure known to cause post-operative nausea and vomiting receives an aprepitant injection.
3. A patient with a history of severe motion sickness receives an aprepitant injection before embarking on a long journey.
4. A patient receiving high-dose chemotherapy for a hematological malignancy receives an aprepitant injection as part of their antiemetic regimen.
5. A patient undergoing radiation therapy for head and neck cancer receives an aprepitant injection to manage treatment-related nausea and vomiting.