Summary & Overview
HCPCS C9052: Injection, ravulizumab-cwvz, 10 mg
HCPCS Level II code C9052 designates a 10 mg unit of ravulizumab-cwvz, a complement inhibitor administered as an injectable biologic. This code is used for billing the medication component of infusion or injection encounters involving ravulizumab-cwvz and is relevant to hospitals, infusion centers, specialty clinics, and payers managing high-cost biologic therapies. Nationally, accurate use of C9052 affects claims adjudication, patient access, and cost reporting for rare-disease and specialty-medication treatment regimens.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical and billing context for C9052, typical sites of service, and what to expect in claims workflows. The publication outlines benchmarks and coverage considerations, explains common billing scenarios for monoclonal antibody injections, and summarizes policy trends that influence reimbursement and prior authorization practices. The content is designed to help billing professionals, revenue cycle managers, and policy analysts understand where C9052 fits in service lines and payer interactions, and to clarify documentation and unitization implications for medication administration claims.
Billing Code Overview
HCPCS Level II code C9052 represents injection, ravulizumab-cwvz, 10 mg. This billing code denotes a single unit of the specified monoclonal antibody formulation for intravenous or subcutaneous administration depending on clinical protocol. The service type is medication administration (injectable biologic therapy). The typical site of service is outpatient infusion centers, hospital outpatient departments, specialty clinics, or other ambulatory settings where infused or injected biologic therapies are delivered.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with paroxysmal nocturnal hemoglobinuria (PNH) or atypical hemolytic uremic syndrome (aHUS) who requires maintenance or initiation therapy with ravulizumab-cwvz. The service is an intravenous injection/infusion of C9052 (ravulizumab-cwvz), billed per 10 mg unit, administered in an outpatient infusion center, hospital outpatient department, or oncology/hematology clinic. The clinical workflow begins with a physician or advanced practice provider visit to confirm indication and recent laboratory monitoring (hemoglobin, LDH, renal function, complement assays as appropriate), pre-infusion medication reconciliation, and insurance verification. On the day of service, an infusion nurse performs venous access, verifies patient identity, confirms dosage and lot number, prepares the drug under USP <797> conditions or pharmacy protocol, performs the infusion per manufacturer dosing and monitoring guidelines, monitors for infusion reactions during and after administration, documents medication administration details (dose, units, lot number, site, start/stop times), and completes billing using C9052 units. Typical post-infusion activities include observation for adverse effects, scheduling the next dose, and documentation in the electronic medical record for continuity of care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 |