Summary & Overview
HCPCS Level II C9056: Injection, givosiran, 0.5 mg
HCPCS Level II code C9056 denotes the injectable drug givosiran in 0.5 mg units. Givosiran is a targeted therapeutic delivered by injection, and coding for its administration is critical for accurate billing, utilization tracking, and pharmacy benefit management across outpatient settings. Nationally, precise HCPCS coding supports appropriate reimbursement, inventory control, and clinical documentation for specialty injectables.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, typical sites of service for administration, and context on why correct HCPCS Level II coding matters for specialty drug management. The publication also outlines benchmarks for unit-based billing, common issues in claim adjudication, and recent policy considerations affecting specialty injectable billing.
The content is organized to help coding professionals, revenue managers, and clinical administrators understand the billing intent of C9056, interpret its use in outpatient infusion and clinic settings, and identify policy and operational items to monitor when managing givosiran therapy.
Billing Code Overview
HCPCS Level II code C9056 describes Injection, givosiran, 0.5 mg. The code represents a drug administration entry for the therapeutic agent givosiran in 0.5 mg increments.
-
Service type: Drug administration (injectable therapeutic)
-
Typical site of service: Outpatient infusion or ambulatory clinic setting, including physician offices and outpatient infusion centers
Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and detailed service line information.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with acute hepatic porphyria (AHP) experiencing recurrent, severe neurovisceral attacks characterized by abdominal pain, neuropathy, nausea, vomiting, and autonomic dysfunction. The patient has a confirmed diagnosis of AHP with elevated urinary aminolevulinic acid (ALA) and porphobilinogen (PBG) and meets criteria for givosiran therapy. The clinical workflow begins with a hematology, genetics, or neurology consultation to confirm diagnosis and discuss therapy risks and monitoring. Baseline labs include liver function tests, serum creatinine, complete blood count, and pregnancy testing for women of childbearing potential. Givosiran is supplied as a vial and dosed by weight; billing is per 0.5 mg unit via HCPCS Level II code C9056 for the administered drug. The medication is administered by a trained clinician or infusion nurse via subcutaneous injection in an outpatient specialty clinic or ambulatory infusion center. Post-injection observation is performed for immediate adverse reactions and patient education is provided on expected effects and monitoring parameters. Follow-up visits include periodic liver enzyme monitoring and assessment of attack frequency to evaluate clinical response and guide ongoing therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure |