How To Use HCPCS Code C9481

HCPCS code C9481 describes an injection of reslizumab, with a dosage of 1 mg. This code is used to identify the administration of this specific medication in medical coding and billing processes. In this article, we will explore the details of HCPCS code C9481, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS C9481?

HCPCS code C9481 is used to identify the injection of reslizumab, a medication with a dosage of 1 mg. This code is specific to the administration of reslizumab and should not be used for any other medications or procedures.

2. Official Description

The official description of HCPCS code C9481 is “Injection, reslizumab, 1 mg.” This description accurately represents the purpose and dosage of the medication being administered.

3. Procedure

1. The provider prepares the reslizumab injection according to the manufacturer’s instructions.
2. The provider verifies the patient’s identity and confirms the correct dosage of 1 mg.
3. The provider selects an appropriate injection site and cleanses the area with an antiseptic solution.
4. The provider uses a sterile syringe and needle to administer the reslizumab injection into the patient’s subcutaneous tissue.
5. After the injection, the provider disposes of the used syringe and needle in a sharps container.
6. The provider documents the administration of the reslizumab injection in the patient’s medical record.

4. When to use HCPCS code C9481

HCPCS code C9481 should be used when the provider administers a 1 mg dosage of reslizumab to a patient. It is important to ensure that the medication being administered is indeed reslizumab and that the dosage matches the code description. This code should not be used for any other medications or dosages.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9481, healthcare providers should ensure that the administration of the reslizumab injection is properly documented in the patient’s medical record. This documentation should include the date and time of the administration, the dosage of 1 mg, and any relevant patient information. Additionally, providers should follow the billing guidelines set forth by the relevant insurance companies or payers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9481 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 C9481 was terminated on December 31, 2016, and is no longer in use.

7. Medicare and Insurance Coverage

HCPCS code C9481 may have specific coverage instructions that apply, as indicated by the coverage code D. It is essential for healthcare providers to review the coverage guidelines provided by Medicare or other insurance companies to determine the reimbursement eligibility for the administration of reslizumab. The pricing indicator code 57 suggests that the pricing for this code is determined by other carriers, and the multiple pricing indicator code A indicates that it is not applicable as HCPCS priced under one methodology. Providers should consult the Medicare Carriers Manual Reference Section Number 2130 for further guidance on billing and reimbursement for HCPCS code C9481.

8. Examples

Here are five examples of when HCPCS code C9481 should be billed:

1. A patient with severe asthma receives a 1 mg injection of reslizumab as part of their treatment plan.
2. A healthcare provider administers a 1 mg dosage of reslizumab to a patient with eosinophilic granulomatosis with polyangiitis.
3. A patient with chronic rhinosinusitis receives a 1 mg injection of reslizumab to manage their symptoms.
4. A healthcare provider administers a 1 mg dosage of reslizumab to a patient with uncontrolled asthma.
5. A patient with allergic bronchopulmonary aspergillosis receives a 1 mg injection of reslizumab as part of their treatment regimen.