Summary & Overview
HCPCS C9047: Injection, caplacizumab-yhdp, 1 mg
HCPCS Level II code C9047 denotes the injectable biologic product caplacizumab-yhdp at a 1 mg unit. Caplacizumab is used in acute immune-mediated thrombotic thrombocytopenic purpura (iTTP) management and is billed as a drug/product unit rather than a procedural administration code. Nationally, accurate coding for high-cost specialty injectables like caplacizumab-yhdp affects payer coverage determinations, reimbursement processes, and patient access to specialty therapeutics.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents and where the service is typically delivered, plus guidance on the types of benchmarks and policy topics usually associated with specialty injectable billing: coverage policies, unit-based billing practices, site-of-service implications, and claims adjudication factors. The summary addresses clinical context for use and national implications for billing and access. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code C9047 represents Injection, caplacizumab-yhdp, 1 mg. This code describes the billing entry for administration of caplacizumab-yhdp, an injectable biologic therapy dosed per milligram.
Service Type: Injection/Injection Product Administration
Typical Site of Service: Outpatient infusion clinic, hospital outpatient department, or ambulatory care setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with acquired thrombotic thrombocytopenic purpura (aTTP) presenting to a hospital or outpatient infusion center after confirmation of ADAMTS13 deficiency and clinical diagnosis. The patient often arrives with thrombocytopenia, microangiopathic hemolytic anemia, and variable neurologic or renal symptoms. Initial management includes plasma exchange and immunosuppression (for example, corticosteroids and rituximab). C9047 (injection, caplacizumab-yhdp, 1 mg) is administered as an antithrombotic biologic to inhibit von Willebrand factor–mediated platelet aggregation; dosing typically begins with an intravenous or subcutaneous loading dose at the time of the first plasma exchange, followed by daily subcutaneous injections. Typical workflow: patient assessment and consent → verification of diagnosis and baseline labs (CBC, hemolysis markers, ADAMTS13) → vascular access and plasma exchange setup → preparation and administration of C9047 by an oncology/hematology-trained RN or infusion pharmacist → monitoring for bleeding, allergic reactions, and platelet response → documentation of lot number, dose, route, site, and associated ICD-10 diagnosis in the medical record. Typical sites of service include inpatient hospital wards, hospital outpatient departments, and ambulatory infusion centers experienced in biologic injections and plasma exchange procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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