Summary & Overview
HCPCS C9093: Ranibizumab Sustained-Release Intravitreal Implant, 0.1 mg
HCPCS Level II code C9093 represents the sustained-release intravitreal implant delivery of ranibizumab (Susvimo), 0.1 mg. This code identifies a procedure-based drug administration that is clinically important for long-acting treatment of retinal conditions requiring intravitreal anti-VEGF therapy. Nationally, precise coding for implantable delivery systems affects claims processing, provider reimbursement workflows, and access to long-acting ophthalmic therapies.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for using a ranibizumab implant, coding implications for outpatient ophthalmology and ambulatory surgery settings, and what to expect in payer coverage considerations. The publication outlines typical billing elements, common modifiers (listed elsewhere), and payer-specific policy contours where available.
The analysis will help revenue cycle, clinical, and policy stakeholders understand coding classification, typical sites of service, and how this HCPCS Level II code fits into broader ambulatory ophthalmic drug delivery practice. Data not available in the input will be explicitly noted in relevant sections.
Billing Code Overview
HCPCS Level II code C9093 describes Injection, ranibizumab, via sustained release intravitreal implant (Susvimo), 0.1 mg. The service is an intravitreal sustained-release implant administration of ranibizumab, a biologic agent used in ophthalmology for intravitreal therapy. The service type is procedure-based drug delivery via an implant. The typical site of service is the outpatient ophthalmology clinic or ambulatory surgery center where intravitreal procedures and implant placements are performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with neovascular (wet) age-related macular degeneration presents for intravitreal therapy. The retina specialist evaluates visual acuity, performs a slit-lamp exam and dilated fundus exam, and obtains optical coherence tomography to confirm subretinal/intraretinal fluid and choroidal neovascularization activity. The patient is scheduled for placement of a sustained-release intravitreal ranibizumab implant (Susvimo, C9093) because of prior good response to ranibizumab and/or to reduce treatment frequency. The clinical workflow includes pre-procedure counseling and informed consent, topical antisepsis and anesthesia, placement of the sustained-release implant via the approved surgical technique in an outpatient ambulatory surgery center or office-based procedure room equipped for intraocular procedures, post-procedure intraocular pressure check, topical antibiotic and steroid regimen, and scheduled follow-up visits with OCT imaging to monitor implant function and retinal status. Typical sites of service are an ambulatory surgery center or a facility-certified ophthalmic procedure room; the procedure is performed by a vitreoretinal surgeon or ophthalmologist credentialed to place intravitreal sustained-release implants.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |