Summary & Overview
HCPCS C9051: Omadacycline Injection, 1 mg
HCPCS Level II code C9051 identifies a unit of omadacycline for injection at a dose of 1 mg. As an injectable antibiotic, this code is used to bill for the medication component when omadacycline is administered parenterally in settings such as outpatient infusion centers, ambulatory clinics, or hospital outpatient departments. Nationally, accurate use of HCPCS Level II code C9051 matters for inventory control, drug cost reporting, and claims adjudication for newer or specialty antimicrobials.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for injectable omadacycline, what the code represents on a claim, and the payer landscape addressed. The publication summarizes benchmark considerations for billing units, common sites of service where the code appears, and relevant policy updates affecting HCPCS drug coding and reimbursement. It also provides practical guidance on claim documentation elements typically associated with injectable drug billing, and notes where input data was not available for specific fields such as modifiers, associated taxonomies, and ICD-10 diagnosis crosswalks.
Billing Code Overview
HCPCS Level II code C9051 represents injection, omadacycline, 1 mg. This billing code denotes a parenteral administration of the antibiotic omadacycline, measured per milligram.
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Service type: Drug administration (injectable)
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Typical site of service: Outpatient infusion/ambulatory care or hospital outpatient setting, depending on clinical need and medication administration protocols.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a confirmed or suspected acute bacterial skin and skin structure infection (ABSSSI) or community-acquired bacterial pneumonia (CABP) who requires intravenous or parenteral antibiotic therapy with omadacycline. The patient presents to an outpatient infusion center, emergency department observation unit, or inpatient hospital setting with symptoms such as fever, localized erythema, cellulitis, purulent drainage, or signs of pneumonia including cough, dyspnea, and radiographic consolidation. After clinical evaluation, cultures as indicated, and assessment of drug allergies and oral tolerance, the clinician orders parenteral omadacycline using billing code C9051 (Injection, omadacycline, 1 mg). The workflow typically includes medication order entry, pharmacy compounding/verification, administration by a registered nurse or qualified clinician, documentation of dose and lot number, and monitoring for infusion reactions or gastrointestinal adverse effects. Follow-up includes clinical reassessment, repeat cultures if warranted, and transition to oral therapy when appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated evaluation and management service by the same physician during a postoperative period | Use when an unrelated E/M is billed during a global postoperative period alongside administration of . |