Summary & Overview
HCPCS C9026: Injection, Vedolizumab, 1 mg
HCPCS Level II code C9026 designates a 1 mg unit of vedolizumab supplied for injection. Vedolizumab is a monoclonal antibody used for inflammatory bowel diseases and other approved indications; reporting per-milligram HCPCS supply codes is essential for accurate drug billing, dose tracking, and reimbursement. Nationally, standardized unit reporting affects hospital and outpatient drug cost accounting, payer contract administration, and patient financial liability calculations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of billing and reporting practices for HCPCS Level II drug units, national benchmarks for coding and utilization where available, considerations for infusion and outpatient settings, and relevant policy updates that influence coverage and billing for high-cost biologic injectables.
The publication provides clinical context for vedolizumab as an infused biologic, explains the implications of per-milligram supply coding for claims and reimbursement workflows, and outlines areas where payer policies and reimbursement methodologies commonly vary. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code C9026 represents an injection of vedolizumab, 1 mg. This code denotes the pharmaceutical supply for vedolizumab in a per-milligram unit, used when reporting the administered dose of the biologic.
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Service type: Drug administration (intravenous biologic therapy supply)
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Typical site of service: Infusion center, hospital outpatient department, physician office, or other outpatient settings where intravenous biologic therapies are administered.
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Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with moderate-to-severe ulcerative colitis is scheduled for outpatient administration of intravenous vedolizumab. The patient presents to an ambulatory infusion center at the gastroenterology clinic for a standard induction or maintenance infusion. Prior to administration, nursing performs medication reconciliation, reviews recent laboratory tests (CBC, LFTs), verifies weight and allergies, and confirms authorization and indication. The infusion is delivered via peripheral IV or implanted port over the manufacturer-recommended infusion time while nursing monitors vital signs and for infusion reactions. Post-infusion, the patient is observed for a short recovery period, documented in the infusion record, and scheduled for the next dose per the gastroenterologist’s treatment plan. Billing captures the drug quantity in milligrams using the HCPCS Level II code C9026 (injection, vedolizumab, 1 mg) along with appropriate administration and facility charges when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a documented E/M visit is medically necessary and distinct from the infusion encounter on the same day |