Summary & Overview
HCPCS C9041: Injection, Andexxa 10 mg, Recombinant Factor Xa Reversal
HCPCS Level II code C9041 designates a 10 mg injectable dose of recombinant, inactivated coagulation factor Xa reversal agent (andexxa). This high-cost, acute-use medication is used to counteract the anticoagulant effects of factor Xa inhibitors in potentially life-threatening bleeding or before urgent procedures, making it clinically significant across hospital and emergency settings nationwide. Coverage, prior authorization, and coding accuracy for C9041 affect patient access and facility billing workflows.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what C9041 represents clinically and operationally, along with national benchmarking and policy context where available. The publication summarizes reimbursement benchmarks, common utilization drivers for andexxa administration, and recent policy updates that influence payer coverage and hospital billing practices.
The report helps coding, billing, and revenue teams understand documentation expectations and payer considerations for acute reversal therapy billed with C9041. Data limitations are noted where input was not provided. The focus is national and intended to inform payers, hospital administrators, and clinical teams about the billing and policy landscape relevant to this injectable reversal agent.
Billing Code Overview
HCPCS Level II code C9041 describes an injection of coagulation factor Xa (recombinant), inactivated (andexxa), 10 mg. The service is a medication administration of a recombinant, inactivated factor Xa reversal agent provided as an injectable dose.
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Service type: Medication administration (injectable coagulation factor Xa reversal agent)
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Typical site of service: Hospital inpatient or outpatient settings where acute reversal of factor Xa inhibitors is required, including emergency departments and procedural areas
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 72-year-old male on apixaban for nonvalvular atrial fibrillation presents to the emergency department with acute, life-threatening gastrointestinal bleeding and hemodynamic instability. After rapid assessment, the patient requires urgent reversal of factor Xa inhibitor activity prior to endoscopic intervention. The clinical workflow begins with stabilization (airway, breathing, circulation), large-bore IV access, blood product availability, and laboratory tests including coagulation panel and anti–factor Xa activity if available. Once the decision for pharmacologic reversal is made, the pharmacy prepares C9041 (andexanet alfa) 10 mg vials per the dosing protocol; administration is performed in the ED or intensive care unit by an emergency medicine or critical care clinician with nursing support. Monitoring continues for hemostasis, thrombotic risk, and need for subsequent procedures such as endoscopy or vascular intervention. Documentation includes indication (life-threatening or uncontrolled bleeding due to a factor Xa inhibitor), dose administered, lot numbers, time of administration, and concurrent hemostatic measures and transfusions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when clinical services for administration are substantially greater than typical due to complexity (document rationale and time). |
| Professional component | Not typically applicable to drug administration; use only if separate professional component is billed for a diagnostic service in conjunction.