Summary & Overview
HCPCS Level II C9080: Injection, melphalan flufenamide hydrochloride, 1 mg
HCPCS Level II code C9080 denotes the injectable oncology agent melphalan flufenamide hydrochloride, billed per 1 mg unit. As a drug-specific HCPCS Level II code, C9080 is used by providers to report administration and acquisition of this chemotherapeutic compound in outpatient infusion settings. Nationally, drug-specific HCPCS codes matter because they support standardized billing, payer coverage decisions, and tracking of utilization and costs for high-cost oncology therapies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage considerations, common billing modifiers, and typical sites of service relevant for parenteral oncology agents. The publication outlines benchmark topics such as reimbursement coding practices, billing units and reporting conventions, and clinical context for infusion administration. It also highlights policy areas to monitor, including prior authorization trends and medical necessity criteria applied by major payers. This summary provides a concise reference for billing professionals, revenue cycle staff, and oncology practice administrators seeking clarity on how C9080 is reported and managed across common payer types.
Billing Code Overview
HCPCS Level II code C9080 describes Injection, melphalan flufenamide hydrochloride, 1 mg. This code represents a specific chemotherapy drug formulation administered by injection. The service type is a parenteral oncologic drug administration. The typical site of service is outpatient infusion centers, hospital outpatient departments, and oncology clinics where intravenous or intramuscular chemotherapy agents are given.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with relapsed or refractory multiple myeloma being considered for treatment with melphalan flufenamide (melflufen) administered by intravenous or intralesional injection as part of a systemic chemotherapy regimen or a targeted therapy protocol. The oncology clinic visit includes review of prior therapies, baseline labs (CBC, CMP), assessment of performance status, and confirmation of venous access (peripheral IV or implanted port). The medication is prepared by pharmacy under sterile conditions. During the encounter, the oncology advanced practice provider or physician documents indication, dose in milligrams, route, lot number, and site of administration; obtains informed consent; and records any infusion-related premedications (antiemetic, steroid). Typical workflow steps: patient check-in and vitals → nurse assessment and IV/port access → medication verification by pharmacist and nurse → administration of C9080 (melphalan flufenamide hydrochloride, 1 mg units billed per mg) → observation for acute reactions → documentation of dose administered, any modifiers (for reduced services, unusual circumstances, or bilateral procedures where applicable), and follow-up plan. Common settings include outpatient oncology infusion centers, hospital outpatient departments, and ambulatory surgical centers equipped to deliver chemotherapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |