How To Use HCPCS Code C9494

HCPCS code C9494 describes the injection of ocrelizumab, with a dosage of 1 mg. This code is used to identify the administration of this specific medication. In this article, we will explore the details of HCPCS code C9494, 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 C9494?

HCPCS code C9494 is used to identify the injection of ocrelizumab, with a dosage of 1 mg. This code specifically refers to the administration of this medication and is used by medical coders to accurately document and bill for this service.

2. Official Description

The official description of HCPCS code C9494 is “Injection, ocrelizumab, 1 mg.” This description clearly states the specific medication and dosage that is being administered.

3. Procedure

1. The provider prepares the ocrelizumab medication for injection.
2. The patient is positioned appropriately for the injection.
3. The provider cleans the injection site with an antiseptic solution.
4. The provider uses a sterile syringe and needle to administer the ocrelizumab injection.
5. After the injection, the provider disposes of the used syringe and needle in a sharps container.

4. When to use HCPCS code C9494

HCPCS code C9494 should be used when a healthcare provider administers ocrelizumab to a patient. This code is specific to the injection of ocrelizumab with a dosage of 1 mg. It is important to ensure that the documentation supports the use of this code and that the patient meets any eligibility criteria or guidelines for receiving this medication.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9494, healthcare providers should ensure that the documentation clearly indicates the administration of ocrelizumab with a dosage of 1 mg. The documentation should include the date of service, the patient’s medical record number, the provider’s name and credentials, and any relevant clinical notes or indications for the administration of this medication.

6. Historical Information and Code Maintenance

HCPCS code C9494 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 a termination date of December 31, 2017, indicating that it is no longer in use. The termination of this code means that it is no longer valid for billing purposes.

7. Medicare and Insurance Coverage

HCPCS code C9494 may have specific coverage instructions that apply, as indicated by the coverage code D. It is important to review the specific coverage guidelines provided by Medicare or other insurance carriers to determine if this code is payable. The pricing indicator code 57 indicates that this code is priced by other carriers, and the multiple pricing indicator code A indicates that it is not applicable as HCPCS priced under one methodology. Healthcare providers should consult the Medicare Carriers Manual Reference Section Number 2130 for additional information on coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code C9494 should be billed:

1. A patient with multiple sclerosis receives an injection of ocrelizumab as part of their treatment plan.
2. A healthcare provider administers ocrelizumab to a patient with rheumatoid arthritis.
3. An oncologist administers ocrelizumab to a patient with lymphoma.
4. A patient with lupus nephritis receives an injection of ocrelizumab to manage their condition.
5. A healthcare provider administers ocrelizumab to a patient with primary progressive multiple sclerosis.