Summary & Overview

HCPCS Level II C9077: Injection, Cabotegravir and Rilpivirine, 2mg/3mg

HCPCS Level II code C9077 denotes the injectable combination of cabotegravir and rilpivirine (2 mg/3 mg), a long-acting antiretroviral formulation used in outpatient administration for HIV management. Nationally, this code matters because it standardizes billing for a high-cost, specialty injectable therapy that impacts payer coverage policy, site-of-care decisions, and access to maintenance antiretroviral regimens.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the medication, typical sites of service for administration, and what to expect when mapping services to this HCPCS Level II code. The publication provides benchmarks and policy-relevant information about coverage patterns and reimbursement considerations where available; it also summarizes clinical use cases and operational implications for infusion and outpatient clinics.

The content is intended for national audiences including billing specialists, revenue cycle professionals, pharmacy and therapeutics committees, and policy analysts seeking a clear reference for coding and service classification for this long-acting injectable antiretroviral combination.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9077HCPCS Level IIinjectable antiretroviralcabotegravirrilpivirineoutpatient infusionHIV treatmentspecialty medication

Billing Code Overview

HCPCS Level II code C9077 describes Injection, cabotegravir and rilpivirine, 2mg/3mg. This code represents a combination injectable antiretroviral therapy formulated as a 2 mg/3 mg unit dose of cabotegravir and rilpivirine for parenteral administration. The service type is an injectable long-acting antiretroviral medication. The typical site of service is outpatient clinical settings where intramuscular or parenteral long-acting HIV treatments are administered, such as specialty infusion clinics, ambulatory infusion centers, physician offices, or HIV treatment clinics.

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Clinical & Coding Specifications

Clinical Context

A typical patient is an adult living with HIV-1 who has achieved viral suppression on a stable oral antiretroviral regimen and is being transitioned to or maintained on long-acting injectable therapy with cabotegravir and rilpivirine. The service represented by C9077 is administration of the combined injectable product (cabotegravir 2 mg / rilpivirine 3 mg per recorded unit) supplied for intramuscular injection. The clinical workflow involves pre-injection assessment (vital signs, review of viral load and adherence history, screening for injection-site infection or contraindications), patient consent and education about expected injection-site reactions and systemic adverse effects, preparation of the medication by pharmacy or authorized staff, intramuscular injection (typically gluteal) by an authorized clinician or nurse, and post-injection observation for immediate adverse reactions. Medication reconciliation and documentation include lot numbers, expiration dates, injection site, dose units administered, and any immediate adverse events. Follow-up scheduling for the next maintained dosing interval (e.g., monthly or every two months per the prescribing regimen) and coordination with payer/benefit authorization are part of the same encounter.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When services provided during the encounter require substantially greater work than typical for the injection visit (rare for standard IM injection).
`23`	Unusual anesthesia	When general or regional anesthesia is medically necessary and documented for the procedure (uncommon for routine IM injection).
`52`	Reduced services	When the full service was not performed as described by the code, and documentation supports partial performance.
`53`	Discontinued procedure	When the injection or procedure was started but discontinued due to unforeseen complications or patient intolerance.
`54`	Surgical care only	If only the surgical component is billed separately by a surgeon — typically not applicable to routine injections.
`55`	Postoperative management only	When only postoperative care is billed separately — rarely applicable for this service.
`56`	Preoperative management only	When only preoperative care is billed separately — rarely applicable.
`62`	Two surgeons	When two surgeons work together as primary surgeons — not typical for medication injections but available if applicable.
`78`	Unplanned return to OR	For unplanned return to the operating room for a related procedure — not typical for this service.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare patients	When services are furnished by these non-physician practitioners and billed under appropriate supervision rules.
`CO`	Services related to a worker's compensation case	When the injection encounter is related to a worker's compensation claim.
`CQ`	Payment for services on or after 1/1/2022 when performed by a CRNA as the sole anesthetist	Rarely applicable; included per modifier list.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not typical for IM injections but listed when anesthesia direction is billed.
`QX`	CRNA service: CRNA with modifier QX appended when applicable	Only used when CRNA furnishes services meeting payer rules.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Infectious Disease Specialist	Manages selection and monitoring of long-acting antiretroviral therapy.
`208000000X`	Internal Medicine	Primary care or HIV-specialty primary physicians who administer or supervise therapy.
`363LF0000X`	Nurse Practitioner	NP who performs assessment and administers injections in ambulatory clinic.
`367A00000X`	Physician Assistant	PA who provides clinical care and administers injections under supervision.
`354E00000X`	Clinical Pharmacist	Pharmacist involved in preparation, verification, and counseling for injectable antiretroviral therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B20`	HIV disease	Primary diagnosis indicating HIV-1 infection; long-acting cabotegravir and rilpivirine are indicated for maintenance therapy in virologically suppressed adults.
`Z21`	Asymptomatic human immunodeficiency virus [HIV] infection status	Used when a patient with HIV is asymptomatic and on suppressive therapy; documents status during maintenance injections.
`R50.9`	Fever, unspecified	Relevant for documenting systemic symptoms that may contraindicate immediate injection or warrant postponement.
`T88.7XXA`	Failure and reaction to administered drug, initial encounter	Used if the patient experiences an adverse reaction to the injectable therapy during the encounter.
`L03.311`	Cellulitis of right buttock	Example of an injection-site infection diagnosis that would impact administration and require treatment or delay of injection.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly used to report the actual intramuscular injection administration when separately billable alongside the medication supply code.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used if concomitant IV therapy or infusion services are provided during the visit (infrequent for IM injectables).
`36415`	Collection of venous blood by venipuncture	Performed for baseline or follow-up viral load and safety labs prior to or during the injection visit.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Typical E/M level for follow-up visits associated with maintenance injection visits when a focused assessment is performed.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate	Example of an ancillary counseling CPT that may be provided during the same visit if relevant to patient care (behavioral counseling services).