Summary & Overview
HCPCS C9049: Injection, tagraxofusp-erzs, 10 mcg
HCPCS Level II code C9049 identifies the 10 mcg vial of tagraxofusp-erzs, a targeted oncology biologic administered by injection or infusion. This national-level billing code matters because it standardizes reporting for a high-cost, specialty oncology drug used in inpatient-outpatient infusion settings and informs coverage, reimbursement, and utilization monitoring across payers. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents clinically, where the service is typically delivered, and which major payers have been considered. The publication outlines benchmarking information, expected billing and coding context for facility and professional claims, and any recent policy updates affecting coverage and billing workflows. Clinical context covers the drug formulation, administration route, and common care settings for oncology infusions. For items not provided in the source input—such as specific modifiers, associated taxonomies, ICD-10 indications, and related billing codes—the report notes that data are not available in the input and omits those details.
Billing Code Overview
HCPCS Level II code C9049 denotes Injection, tagraxofusp-erzs, 10 mcg. This code represents a specific parenteral administration of the oncology agent tagraxofusp-erzs, packaged in a 10 microgram unit.
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Service type: Drug injection (intravenous infusion or injection of a biologic oncology therapy)
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Typical site of service: Hospital outpatient, infusion center, or physician office infusion suite
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN) who presents to an outpatient infusion center or hospital outpatient department for administration of targeted therapy. The attending hematologist/oncologist prescribes C9049 (Injection, tagraxofusp-erzs, 10 mcg) dosed per body weight and treatment cycle. Prior to infusion, nursing performs baseline vital signs, reviews recent labs including complete blood count, liver function tests, and albumin, and confirms eligibility criteria. The medication is prepared by pharmacy in an aseptic environment, labeled and delivered to the infusion suite. During administration, the patient is monitored for capillary leak syndrome and infusion reactions; supportive medications (antipyretics, antiemetics) are available. Post-infusion observation occurs per institutional protocol (typically 1–2 hours) and documentation includes lot number, dose administered, route, and any adverse events. Billing for the drug is submitted using HCPCS Level II code C9049 with facility or professional modifiers as appropriate, and revenue and payer adjudication follow standard oncology drug reimbursement workflows.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered to patient | Use when a portion of the single-use vial is discarded after administration of and the discarded amount must be reported. |