Summary & Overview
HCPCS Level II C9078: Injection, trilaciclib, 1 mg
HCPCS Level II code C9078 denotes the injectable cancer-supportive agent trilaciclib, billed per 1 mg unit. The code captures administration of trilaciclib, a myelopreservation agent given prior to cytotoxic chemotherapy to help protect bone marrow function. Nationally, accurate coding for novel oncology agents influences coverage determinations, reimbursement, and care coordination across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for trilaciclib, standard service settings where the injection is delivered, and what to expect in payer coverage and claims processing. The publication highlights benchmarks and payment considerations relevant to hospital outpatient departments and oncology infusion centers, notes common modifiers used in practice (provided separately), and summarizes typical documentation elements needed to support medical necessity.
This piece gives clinicians, billing professionals, and policy stakeholders a national-level briefing on how HCPCS Level II code C9078 functions in practice, where it is billed, and the administrative elements that affect reimbursement and claims adjudication. Data not available in the input for detailed payer-specific rates, associated taxonomies, and ICD-10 diagnoses are noted where applicable.
Billing Code Overview
HCPCS Level II code C9078 represents Injection, trilaciclib, 1 mg. This code is used to bill for the drug trilaciclib when administered as an injectable product. The service type is drug administration (injectable therapy), and the typical site of service is outpatient infusion or oncology clinic, where antineoplastic supportive agents are commonly delivered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical scenario involves an adult oncology patient scheduled to receive intravenous chemotherapy that has a high risk of myelosuppression, such as combination regimens for small cell lung cancer or other solid tumors where trilaciclib is indicated. The patient arrives to an outpatient oncology infusion center or hospital outpatient infusion suite for planned chemotherapy. Prior to chemotherapy start, the oncology nurse or pharmacist verifies the order for C9078 (Injection, trilaciclib, 1 mg), confirms patient identifiers and allergy history, and prepares the dose based on the prescribed milligram amount. Trilaciclib is administered intravenously as a short infusion or bolus prior to initiation of the cytotoxic chemotherapy on the same day to reduce the incidence of chemotherapy-induced myelosuppression. Documentation includes indication, dosage, lot number, route, time of administration, and any pre- or post-infusion observations. Typical site of service: outpatient hospital infusion center or outpatient oncology clinic. Typical patient: adult receiving myelosuppressive chemotherapy who requires prophylactic myeloprotection to decrease the risk of neutropenia, anemia, or thrombocytopenia.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to administer or manage trilaciclib is substantially greater than typically required (document justification). |