Summary & Overview
HCPCS C9064: Mitomycin Pyelocalyceal Instillation, 1 mg
HCPCS Level II code C9064 represents mitomycin pyelocalyceal instillation, 1 mg — a targeted intrarenal chemotherapeutic procedure used in urologic oncology to deliver medication directly to the renal pelvis and calyceal system. Nationally, this code standardizes billing for a specialized, procedure-based therapy that can affect payment policy, site-of-service decisions, and access to localized cancer treatments.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for intrarenal mitomycin instillation, typical sites where the service is delivered, common billing modifiers associated with procedural services, and guidance on the types of benchmarks and coverage policy elements that payers commonly address for localized chemotherapeutic instillations. The publication highlights coding considerations, expected service lines, and where to look for payer policy updates.
This summary provides a national perspective useful for billing managers, urology clinicians, and revenue cycle professionals seeking clarity on the purpose of C9064, the clinical setting in which it is used, and the payer landscape relevant to reimbursement and policy review.
Billing Code Overview
HCPCS Level II code C9064 describes mitomycin pyelocalyceal instillation, 1 mg. This service involves the instillation of mitomycin directly into the renal pelvis and calyceal system for local chemotherapeutic treatment.
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Service type: Intrarenal/pyelocalyceal chemotherapeutic instillation
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Typical site of service: Hospital outpatient department, ambulatory surgical center, or specialized urology clinic where intrarenal instillation procedures are performed
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with non–muscle-invasive urothelial carcinoma of the renal pelvis or calyces who requires topical intrapelvicalyceal chemotherapy. The patient presents to an outpatient urology clinic or ambulatory surgery center for instillation of mitomycin into the pyelocalyceal system via an existing percutaneous nephrostomy tube or a ureteral catheter placed cystoscopically. Pre-procedure evaluation includes review of imaging (CT urogram or renal ultrasound), urine cytology, recent labs (basic metabolic panel, creatinine), and verification of the access route. The procedure is performed by a urologist or interventional radiologist: the provider instills 1 mg of mitomycin diluted per institutional protocol into the pyelocalyceal system, orders a dwell time appropriate for the regimen, and documents indication, dose, route, and laterality. Typical sites of service are an ambulatory surgery center, outpatient clinic procedure room, or interventional radiology suite. Common clinical indications include local control or prophylaxis for superficial urothelial carcinoma of the renal pelvis, carcinoma in situ of the upper tract, or adjuvant treatment following endoscopic tumor ablation. Post-procedure monitoring focuses on pain control, signs of systemic absorption or allergic reaction, and confirmation that the instilled agent drained according to plan (if applicable).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |