Summary & Overview
HCPCS C9039: Plazomicin Injection, 5 mg
HCPCS Level II code C9039 denotes a 5 mg unit of plazomicin for injection, an intravenous aminoglycoside-class antibiotic used in serious bacterial infections. Nationally, the code matters because it standardizes reporting and reimbursement for a high-cost, parenteral antimicrobial administered in acute and outpatient infusion settings, affecting hospital drug inventory, outpatient infusion billing, and antimicrobial stewardship budgets.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks for payer coverage policies, typical settings of use, and clinical context for plazomicin administration. The publication summarizes common billing considerations for injectable antimicrobial agents, outlines where C9039 is reported on service lines, and highlights policy updates relevant to HCPCS reporting and reimbursement of specialty injectables.
The report provides practical reference material for revenue cycle managers, pharmacy stewardship teams, and billing professionals seeking clarity on coding, typical sites of service, and payer coverage patterns for injectable plazomicin. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code C9039 describes Injection, plazomicin, 5 mg. This code represents a parenteral antimicrobial agent supplied for intravenous administration. The service type is injectable antibiotic therapy, and the typical site of service is acute care settings such as hospitals and outpatient infusion centers where intravenous antimicrobial infusions are administered.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult hospitalized with a multidrug-resistant gram-negative bloodstream or complicated urinary tract infection unresponsive to standard aminoglycosides. The infectious disease team orders intravenous C9039 (injection, plazomicin, 5 mg) to provide a single-agent or combination aminoglycoside therapy guided by culture and susceptibility results. The clinical workflow includes: a baseline assessment (vital signs, renal function, audiology history), review of microbiology showing susceptibility to plazomicin, pharmacy verification of dose based on weight and renal function, and preparation of the medication for intravenous administration by nursing. Nursing documents administration time, dose, infusion site, and monitors for infusion reactions, ototoxicity, nephrotoxicity, and serum drug levels per facility antimicrobial stewardship protocols. Subsequent daily review by the prescribing clinician includes renal function monitoring and adjustment of dosing or discontinuation based on clinical response and adverse effects. Typical sites of service include inpatient acute care units and hospital observation units where intravenous antimicrobial therapy and monitoring are available.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated evaluation and management service by the same physician during a postoperative period | Use if an unrelated E/M is provided while the patient is in a global surgical/postoperative period unrelated to the drug administration |