C9045 moxetumomab pasudotox — HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS C9045: Injection, moxetumomab pasudotox-tdfk, 0.01 mg

HCPCS Level II code C9045 denotes injection of moxetumomab pasudotox-tdfk, measured per 0.01 mg. This code is used to bill for administration of a targeted biologic therapy in outpatient settings, typically in infusion clinics or physician offices. Nationally, accurate coding for high-cost specialty drugs like moxetumomab pasudotox-tdfk is important for claims processing, utilization tracking, and payment consistency across payers.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the drug, typical sites of service, and the billing unit definition underlying C9045.

The publication provides benchmarks and comparative coverage considerations, summarizes relevant policy updates affecting specialty injectable biologics, and highlights documentation and billing elements payers commonly review for injectable oncology agents. Where source details are not provided, the publication notes that specific modifier usage, associated taxonomies, and diagnosis mappings are not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9045HCPCS Level IImoxetumomab pasudotox-tdfkinjectable biologiconcology infusiondrug administrationoutpatient infusionspecialty pharmacy

Billing Code Overview

HCPCS Level II code C9045 describes administration of moxetumomab pasudotox-tdfk, billed per 0.01 mg of drug. This code represents a biologic injection used in oncology settings for targeted therapy.

Service type: Injection — therapeutic drug administration

Typical site of service: Outpatient infusion clinic or physician office

Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with relapsed or refractory hairy cell leukemia (HCL) who meets specialty oncology criteria for treatment with moxetumomab pasudotox-tdfk. The patient has persistent cytopenias, symptomatic splenomegaly, or progressive marrow involvement after prior therapies (for example, purine analogs). The oncology clinic schedules an infusion visit at an outpatient infusion center or hospital outpatient department. Prior to administration, the patient undergoes verification of diagnosis, review of prior therapies, baseline labs (CBC, chemistries, hepatic and renal function), and assessment for infection. Antihistamine and antipyretic premedication may be given per institutional protocol. Pharmacy compounds the medication in doses calculated from the vial-based unit of 0.01 mg per billing unit for C9045. Nursing performs intravenous infusion according to the prescribing information, monitors for infusion-related reactions and capillary leak syndrome, and documents vital signs and medication administration in the electronic medical record. Post-infusion monitoring includes observation for adverse events, instructions for symptomatic management, and scheduling follow-up visits with laboratory surveillance and oncology assessment to evaluate response and toxicity. Payer billing includes the HCPCS Level II code C9045 reported in units reflecting the total mg administered divided by 0.01 mg per unit, and may be accompanied by site or condition modifiers as applicable for outpatient hospital or physician-administered drug billing.

Coding Specifications

Modifier	Description

HCPCS C9122: Mometasone Furoate Sinus Implant, 10 mcg

HCPCS-C9056-GIVOSIRAN-INJECTION-0-5-MG

HCPCS Level II C9056: Injection, givosiran, 0.5 mg

HCPCS-C7537-PACEMAKER-LEFT-VENTRICULAR-TRANSVENOUS-LEAD-INSERTION

HCPCS C7537: Pacemaker with Atrial and Cardiac Venous LV Lead Insertion

HCPCS-C8900-MAGNETIC-RESONANCE-ANGIOGRAPHY-ABDOMEN-CONTRAST

HCPCS C8900: Magnetic Resonance Angiography with Contrast, Abdomen

HCPCS-C9302-ZANIDATAMAB-INJECTION-2MG

HCPCS Level II C9302: Injection, zanidatamab-hrii, 2 mg

HCPCS-C9148-TECLISTAMAB-INJECTION-0-5-MG

HCPCS Level II C9148: Injection, teclistamab-cqyv, 0.5 mg

HCPCS-C9052-RAVULIZUMAB-INJECTION-10MG

HCPCS C9052: Injection, ravulizumab-cwvz, 10 mg

HCPCS-C9797-PRESSURE-GENERATING-CATHETER-EMBOLIZATION-OCCLUSION

HCPCS Level II C9797: Vascular Embolization Using Pressure-Generating Catheter

HCPCS-C9163-TALQUETAMAB-TGVS-INJECTION-025-MG

HCPCS Level II C9163: Injection, talquetamab-tgvs, 0.25 mg

HCPCS-C9737-ESOPHAGEAL-SPHINCTER-AUGMENTATION-LAPAROSCOPY

HCPCS C9737: Laparoscopic Esophageal Sphincter Augmentation

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Taxonomy Code	Specialty	Notes
`207RH0000X`	Hematology & Oncology	Physicians who prescribe and supervise administration of moxetumomab pasudotox-tdfk.
`2083P0200X`	Medical Oncology	Specialists managing systemic therapy and follow-up for hematologic malignancies.
`207L00000X`	Internal Medicine	Hospitalists or internists involved in inpatient administration or oversight.
`3336S0105X`	Infusion Nurse Specialist	Nursing specialty providing infusion administration and monitoring.
`3336N0002X`	Oncology Nurse	Provides chemotherapy administration and patient education.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C91.4`	Hairy cell leukemia	Primary indicated diagnosis for use of moxetumomab pasudotox-tdfk in relapsed/refractory HCL.
`D72.8`	Other specified disorders of white blood cells	May capture cytopenias or leukocyte abnormalities associated with marrow involvement in HCL.
`D61.9`	Aplastic anemia, unspecified	Represents severe marrow suppression scenarios where HCL-related marrow failure is considered in differential management.
`R53.1`	Weakness	Symptom code commonly documented in patients with progressive hematologic malignancy receiving therapy.
`D74.9`	Disorder of platelet function, unspecified	Used when thrombocytopenia or platelet dysfunction is present and relevant to therapy risk and monitoring.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Typically used for billing the initial infusion encounter when moxetumomab pasudotox-tdfk is administered and infusion time fits the code definition.
`96366`	Intravenous infusion; each additional hour (List separately in addition to code for primary infusion)	Used when infusion of the agent extends beyond the first hour and additional hourly infusion time is billed.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Used by some oncology practices to report chemotherapy/antineoplastic infusion when clinic uses chemotherapy administration CPT codes.
`96415`	Chemotherapy administration; each additional hour (List separately in addition to code for primary infusion)	Used for additional infusion time for chemotherapy agents administered intravenously.
`96360`	Intravenous infusion, hydration (separate procedure)	Billed when intravenous hydration is provided as a separate service during the same visit.
`36415`	Collection of venous blood by venipuncture	Billed for baseline and follow-up laboratory sampling prior to or after drug administration.

`JW`	Drug amount discarded/not administered to the patient	Use when part of the dispensed vial is discarded and documentation supports amount wasted.
`JZ`	Not administered, patient refused to take drug	Use when the drug was not administered because the patient refused after preparation.
`GP`	Services delivered under an outpatient physical therapy plan of care	Data not typically applicable; include only if therapy services are billed with drug administration (rare).
`HC`	Hospital-based outpatient clinic	Use when billing under hospital outpatient clinic methodology where applicable.
`PO`	Medicare - billing indicating services furnished in physician office	Use when the drug is administered in a physician office setting and payer requires this modifier.
`QS`	Monoclonal antibody/chemotherapy administration service	Use as required by some payers to indicate chemotherapy/antineoplastic agent administration supplied under specific billing rules.
`XE`	Separate Encounter, distinct from other services on the same day	Use when the drug administration is a distinct service from other same-day procedures.
`XP`	Separate Practitioner, distinct from other practitioners on the same day	Use when a different practitioner performs the drug administration than other services billed same day.
`XU`	Unusual non-overlapping service	Use when the drug administration is distinct and not typically billed together with other services.
`76`	Repeat procedure by same physician	Use when the same physician repeats the administration/service later the same day.
`77`	Repeat procedure by another physician	Use when a second physician repeats the service the same day.
`59`	Distinct procedural service	Use to indicate a separate and distinct service when payer requires identification for same-day coding.
`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Use when an unrelated E/M is provided during a global period concurrent with drug administration.

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