Summary & Overview
HCPCS C9095: Inj, tebentafusp-tebn, 1 mcg
HCPCS Level II code C9095 designates injectable tebentafusp-tebn in 1 mcg units, a targeted biologic used in oncology care. As a specific drug code, it matters nationally because it standardizes billing for acquisition and administration of this high-cost therapy across outpatient infusion settings and physician offices. Accurate use of the code supports consistent claims processing, pricing transparency, and coverage determinations tied to medical necessity policies for specialty oncology therapeutics.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise account of what C9095 represents clinically and operationally, plus national-level context on payer coverage approaches. The publication summarizes common billing considerations, places the code in the broader outpatient infusion and oncology drug service line, and outlines the types of benchmarks and policy topics typically associated with specialty drug codes—such as unit pricing, site-of-service implications, and claims adjudication patterns.
This summary serves clinicians, revenue cycle staff, and policy analysts who need a clear, national snapshot of HCPCS Level II code C9095, including where it is typically billed and what stakeholders review when evaluating coverage and payment for tebentafusp-tebn.
Billing Code Overview
HCPCS Level II code C9095 represents the drug product tebentafusp-tebn, billed per unit of 1 mcg for injectable administration. The code denotes a specific oncology biologic agent supplied for parenteral use.
Service Type: Injection (intravenous or subcutaneous administration of a biologic agent)
Typical Site of Service: Hospital outpatient infusion center, physician office infusion suite, or ambulatory infusion clinic
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with unresectable or metastatic uveal melanoma requiring targeted immunotherapy. The patient presents to an outpatient oncology infusion center or hospital outpatient department for administration of C9095 (inj, tebentafusp-tebn, 1 mcg). The oncology team — including a medical oncologist, oncology nurse, and infusion pharmacist — verifies indication, dosing based on body weight, baseline labs, and ocular exam given tebentafusp-tebn’s known ocular and cytokine-mediated adverse events. Pre-infusion assessment includes vitals, review of prior infusion reactions, and consent. The pharmacist prepares the dose under sterile technique. The nurse administers the injection intravenously with continuous monitoring during infusion and for a post-infusion observation period to assess for cytokine release syndrome, infusion reactions, hypotension, or ocular toxicity. Documentation includes drug name C9095, lot number, dose in mcg, start/stop times, infusion-related vitals, any administered supportive medications (e.g., antipyretics, antihistamines), and any applicable modifier codes recording special circumstances. Typical sites of service are an outpatient infusion center, physician office equipped for oncology infusions, or hospital outpatient department. The patient often requires follow-up visits for laboratory monitoring and ophthalmology assessment within the first several weeks after initiation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|