C9065 Romidepsin HCPCS Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS C9065: Injection, Romidepsin (Liquid), 1mg

HCPCS Level II code C9065 designates the supply of romidepsin in a non-lyophilized (liquid) formulation, billed per 1 mg. Romidepsin is an antineoplastic agent used in oncology care, and precise billing for drug formulation and unit dosing is essential for claims processing, clinical recordkeeping, and national cost benchmarking. This code matters nationally because injectable oncology therapies represent a significant and growing component of specialty drug spend and utilization in outpatient infusion settings.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a focused overview of clinical context for romidepsin billing, expected sites of service, and the typical service type. The publication summarizes national implications for reimbursement administration, highlights common billing modifiers and claim considerations where available, and points to areas where policy updates or payer-specific coverage rules may affect payment and utilization. Where input data is missing, the content notes that information is not available. The reader will gain a concise resource for understanding HCPCS Level II code C9065 and its role in outpatient chemotherapy billing and claims workflow.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareC9065HCPCS Level IIromidepsinchemotherapyinfusiononcologydrug-billingoutpatient-pharmacy

Billing Code Overview

HCPCS Level II code C9065 represents injection, romidepsin, non-lyophilized (e.g. liquid), 1mg. This billing code denotes a chemotherapy/antineoplastic injectable medication formulation measured per milligram and is used to report administration of romidepsin in its liquid (non-lyophilized) form.

Service type: Medication administration / drug supply for chemotherapy
Typical site of service: Infusion center, hospital outpatient department, or other outpatient clinical settings where intravenous chemotherapy is administered

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a confirmed peripheral T-cell lymphoma or cutaneous T-cell lymphoma who is scheduled to receive intravenous romidepsin as part of systemic chemotherapy. The patient arrives to an outpatient infusion center or hospital outpatient department accompanied by nursing staff and an oncology advanced practice provider. Pre-infusion evaluation includes vital signs, review of baseline labs (complete blood count, comprehensive metabolic panel, liver function tests, electrolytes, and magnesium), ECG review for QTc prolongation risk, and verification of current medications for potential interactions. The romidepsin product described by C9065 is supplied as a non-lyophilized (liquid) formulation dosed per milligram; the order is calculated based on the patient’s body surface area and prescribed mg per dose schedule (for example, 14 mg/m2 on specified days of a 28-day cycle).

During the visit, an IV or implanted port is accessed, and the medication is prepared by pharmacy under sterile conditions. Nursing documents time of infusion start/stop, lot number, and exact milligrams administered to support billing of C9065 per 1 mg units. The infusion is typically administered in an outpatient infusion center, ambulatory infusion suite, or hospital-based infusion clinic. Post-infusion monitoring includes assessment for infusion reactions, laboratory trends, and counseling on adverse effects such as nausea, fatigue, cytopenias, and electrocardiographic changes. Documentation required in the medical record to support billing includes the medication name and formulation, total milligrams administered, date and time of service, infusion site, lot/serial numbers, and clinical rationale tied to an appropriate ICD-10 diagnosis for an FDA‑approved or off-label indication as directed by the treating oncologist.

Coding Specifications

Modifier

HCPCS C9301: Obecabtagene Autoleucel, CD19 CAR T-cell Therapy

HCPCS-C9147-TREMELIMUMAB-ACTL-INJECTION-1MG

HCPCS C9147: Injection, tremelimumab-actl, 1 mg

HCPCS-C9408-IOBENGUANE-I-131-THERAPEUTIC-1-MILLICURIE

HCPCS C9408: Iodine I-131 Iobenguane Therapeutic, 1 millicurie

HCPCS-C9151-PEGCETACOPLAN-INJECTION-INTRAVITREAL-1MG

HCPCS Level II C9151: Injection, pegcetacoplan, 1 mg

HCPCS-C1768-VASCULAR-GRAFT

HCPCS Level II C1768: Graft, Vascular

HCPCS-C9783-CORONARY-SINUS-REDUCTION-IDE-TRANSCATHETER-PROCEDURE

HCPCS C9783: Blinded Transcatheter Coronary Sinus Reduction Implantation

HCPCS-C7506-INTERPHALANGEAL-JOINT-ARTHRODESIS

HCPCS C7506: Arthrodesis of Interphalangeal Joints, With or Without Fixation

HCPCS-C1881-DIALYSIS-ACCESS-SYSTEM-IMPLANTABLE

HCPCS C1881: Dialysis Access System (Implantable)

HCPCS-C9446-TEDIZOLID-PHOSPHATE-INJECTION-1MG

HCPCS C9446: Injection, tedizolid phosphate, 1 mg

HCPCS-C1749-IMPLANTABLE-RETROGRADE-COLONOSCOPE-ENDOSCOPE

HCPCS C1749: Implantable Retrograde Colonoscope Endoscope

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`22`	Increased procedural services	Use when work required to administer or coordinate this infusion is substantially greater than typical (document justification and time).
`23`	Unusual anesthesia	Use if general anesthesia or significant sedation unrelated to the drug itself is required for administration.
`52`	Reduced services	Use when a planned romidepsin infusion is partially reduced or only partially administered.
`53`	Discontinued procedure	Use when infusion is started but discontinued due to patient condition or adverse event (document reason and amount given).
`54`	Surgical care only	Generally not applicable to infusion; only used if billing professional provided intraoperative care separate from postoperative care.
`55`	Postoperative management only	Rare for outpatient infusion; use if only postoperative management is billed by a different provider.
`56`	Preoperative management only	Rarely used; only if pre-procedure evaluation is billed separately by another provider.
`62`	Two surgeons	Uncommon; use if two practitioners share substantial, distinct portions of care related to infusion procedure.
`78`	Return to OR for related procedure	Not typical for infusion; use if patient requires return for a related surgical intervention.
`AS`	Physician assistant, nurse practitioner, clinical nurse specialist billing	Use when a qualified non-physician practitioner performs or supervises the infusion under applicable state rules.
`CO`	Out-of-pocket payer (patients not covered by insurance)	Use when patient elects to self-pay and payer rules require this modifier.
`CQ`	Monoclonal antibody when biosimilar or product is injected — unclassified	Use when reporting certain specialty drug administration per payer guidance; apply only if required by contractor.
`FX`	First assist reduced/limited	Not typically applicable; included only if first-assist duties are truncated during a related surgical encounter.
`FY`	Split/shared E/M	Use when evaluation and management service is split/shared between physician and non-physician practitioner in facility settings.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use only if anesthesia services for the infusion are provided under directed anesthesia model.

Taxonomy Code	Specialty	Notes
`208000000X`	Hematology/Oncology	Medical oncologists and hematologist-oncologists who prescribe and oversee romidepsin therapy.
`207Q00000X`	Medical Oncology	Oncology subspecialists providing systemic chemotherapy infusion care.
`363L00000X`	Infusion Therapy	Registered nurses and infusion specialists who administer and monitor IV chemotherapy.
`341600000X`	Pharmacy	Oncology pharmacists responsible for sterile compounding, dose verification, and drug accountability.
`362Y00000X`	Nurse Practitioner	Advanced practice providers who manage chemotherapy orders, consent, and follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C84.0`	Mycosis fungoides	A type of cutaneous T-cell lymphoma for which romidepsin may be used in systemic therapy.
`C84.4`	Peripheral T-cell lymphoma	Peripheral T-cell lymphomas are among indications for romidepsin treatment regimens.
`C84.9`	T-cell lymphoma, unspecified	Used when T-cell lymphoma is diagnosed but not further specified; romidepsin may be indicated.
`C88.4`	Waldenström macroglobulinemia	Included as a lymphoid malignancy consideration when alternative therapies are used; relevance depends on oncologist judgment.
`C81.9`	Hodgkin lymphoma, unspecified	Lymphoma diagnosis that may require systemic therapy; listed when romidepsin is part of regimen in select cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to primary service)	Used when romidepsin infusion duration requires billing for additional hours beyond the base chemotherapy administration service.
`96415`	Chemotherapy administration, intravenous, push technique, each additional drug (same date)	Applicable when an IV push adjunct medication is administered during the same visit (e.g., antiemetic bolus).
`96417`	Chemotherapy administration, intra-arterial; per hour	Rarely used; included when intra-arterial delivery is part of combined modality (not typical for romidepsin).
`96401`	Chemotherapy administration, IV infusion, up to 1 hour, single or initial substance/drug	Represents the initial chemotherapy infusion service often reported alongside the J/H/HCPCS drug units (drug code `C9065` reported per mg).
`96409`	Chemotherapy administration, IV push, single or initial substance/drug	Used when romidepsin or supportive medications are administered as an IV push per protocol.

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