Summary & Overview
HCPCS C9076: Lisocabtagene maraleucel, Autologous Anti-CD19 CAR T-Cell Dose
HCPCS Level II code C9076 represents lisocabtagene maraleucel, an autologous anti-CD19 CAR T-cell therapeutic dose that includes leukapheresis and dose preparation. This code identifies a high-cost, complex cellular immunotherapy increasingly used in hematologic oncology and is significant for payer policy, billing complexity, and site-of-care considerations across the U.S. health system. Key national payers assessed include Aetna, Blue Cross Blue Shield plans, Cigna, UnitedHealthcare and Medicare.
Readers will find a concise overview of what the code denotes clinically and operationally, how major payers approach coverage and coding implementation, and practical benchmarking and policy context relevant to hospital outpatient infusion centers and specialized cellular therapy programs. The publication covers reimbursement benchmarks, claims handling nuances, common modifiers and billing practice implications, and how payers and Medicare typically frame coverage and prior authorization requirements. It also situates C9076 within broader trends in cellular therapies and the administrative workflows for leukapheresis and dose preparation. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C9076 describes lisocabtagene maraleucel, specified as up to 110 million autologous anti-CD19 CAR-positive viable T cells, and includes leukapheresis and dose preparation procedures, per therapeutic dose. The service is a cellular immunotherapy product intended for infusion of a patient’s engineered autologous T cells.
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Service Type: Cellular immunotherapy product and associated leukapheresis and dose preparation
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Typical Site of Service: Hospital outpatient infusion center or specialized cellular therapy center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with relapsed or refractory B-cell malignancy (for example, diffuse large B-cell lymphoma) who is evaluated for autologous CD19-directed CAR T-cell therapy. The clinical workflow begins with hematology/oncology consultation, determination of candidacy, and informed consent. Leukapheresis is performed to collect peripheral blood mononuclear cells; cells are processed and sent to a manufacturing facility for generation of lisocabtagene maraleucel. During the manufacturing interval the patient may receive bridging therapy. On the scheduled treatment day, lymphodepleting chemotherapy (commonly fludarabine and cyclophosphamide) is administered as an inpatient or outpatient depending on institutional practice and patient status. The cryopreserved, product-specific therapeutic dose (up to 110 million CAR-positive viable T cells) is thawed and prepared; an accredited cellular therapy laboratory performs dose preparation and release testing. The infusion is administered under close monitoring for acute toxicities, including cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome. Post-infusion, patients undergo monitoring in an inpatient setting for the index admission or have outpatient observation with clearly defined escalation criteria. Follow-up includes serial laboratory evaluation, neurology and transplant/hematology visits, and documentation of responses and adverse events for outcomes reporting and billing reconciliation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |