Summary & Overview
HCPCS C9094: Injection, sutimlimab-jome, 10 mg
HCPCS Level II code C9094 denotes the injectable biologic sutimlimab-jome, billed per 10 mg unit. As a specialty therapeutic agent, C9094 is used for precise dosing of a high-cost parenteral product and matters nationally because it affects specialty pharmacy reimbursement, hospital outpatient infusion billing, and payer coverage policies for rare or complex hematologic conditions. Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find an overview of the code’s clinical purpose and common sites of service, typical billing and service-line contexts where the code appears, and a summary of payer coverage patterns and benchmarking approaches. The publication summarizes national-level considerations for claim submission, common modifiers encountered in reporting, and guidance on mapping service lines and infusion settings. It also identifies areas where data are not available in the input and directs readers to typical resources for clinical and reimbursement details.
This summary is aimed at coding professionals, revenue cycle managers, and policy analysts seeking a concise reference for HCPCS Level II code C9094 and its implications for billing and payer interactions.
Billing Code Overview
HCPCS Level II code C9094 describes Injection, sutimlimab-jome, 10 mg. This code represents a parenteral biologic therapy product furnished as an injectable dose.
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Service type: Therapeutic injection (intravenous or subcutaneous administration depending on product labeling and clinician discretion).
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Typical site of service: Hospital outpatient infusion centers, physician offices, and ambulatory infusion clinics, where specialty biologic infusions or injections are delivered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with cold agglutinin disease (CAD) presents for scheduled intravenous administration of C9094 (sutimlimab-jome, 10 mg vial). The patient has a history of symptomatic hemolytic anemia with fatigue, jaundice, and transfusion dependence despite supportive care. Before infusion, the hematology infusion nurse verifies weight, obtains baseline vital signs, reviews recent complete blood count and bilirubin, confirms no active infections, and reviews prior infusion tolerance. The infusion is prepared in an outpatient infusion center by a pharmacy technician under sterile conditions, and the dose is calculated per weight-based protocol using the appropriate number of C9094 vials. During the visit, the nurse places an intravenous catheter, administers pre-medication if indicated per facility protocol, and monitors for infusion-related reactions. Vital signs are recorded pre-infusion, every 15–30 minutes during infusion, and post-infusion. After completion, the patient is observed for delayed hypersensitivity or hemolysis for an appropriate observation period, educated on signs of adverse events, and scheduled for the next dosing visit in accordance with the treatment regimen. Billing uses HCPCS Level II code C9094 for medication administration and may include administration CPT codes and appropriate modifiers as needed for payer adjudication.
Coding Specifications
| Modifier | Description | When to Use |
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