Summary & Overview
HCPCS C9096: Filgrastim-ayow (Releuko) Injection, 1 microgram
HCPCS Level II code C9096 represents injection of filgrastim-ayow, a biosimilar to filgrastim marketed as Releuko, billed per 1 microgram unit. This code identifies administration of a granulocyte colony-stimulating factor used to prevent or treat neutropenia in patients receiving myelosuppressive therapy. Nationally, biologic and biosimilar supportive therapies are important for oncology care pathways and cost management.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of filgrastim-ayow, typical sites of service where the injection is delivered, and the common billing modifiers associated with injectable therapies. The publication also summarizes payer coverage landscape and benchmarking considerations relevant to outpatient administration.
The report provides actionable reference material for coding teams, revenue cycle managers, and policy analysts: code definition and clinical purpose, payer inclusion, typical service lines and sites of care, and areas where policy updates or payer-specific rules frequently affect utilization and billing. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C9096 denotes an injection of filgrastim-ayow, a biosimilar product marketed as Releuko, dosed per 1 microgram units. The service type is therapeutic biologic injection (biosimilar granulocyte colony-stimulating factor) used to stimulate neutrophil production.
Typical site of service is the outpatient clinic or physician office and may also be administered in infusion centers or other ambulatory settings where injectable supportive oncology therapies are delivered.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with chemotherapy-induced neutropenia or at high risk for neutropenic fever who requires granulocyte colony-stimulating factor (G-CSF) support. The clinician prescribes C9096 (injection, filgrastim-ayow, biosimilar, (Releuko), 1 microgram) to be administered subcutaneously once daily starting 24–72 hours after cytotoxic chemotherapy and continuing until neutrophil recovery. The workflow includes oncology or hematology assessment, baseline complete blood count (CBC) with differential, patient education on subcutaneous self-injection or clinic administration, documentation of lot number and dose per vial, and periodic CBC monitoring to guide duration of therapy. Typical sites of service are outpatient oncology infusion centers, physician offices, hospital outpatient departments, and home health settings when home administration is arranged. Common clinical scenarios include primary prophylaxis following myelosuppressive chemotherapy, secondary prophylaxis after prior neutropenic complications, mobilization of peripheral blood progenitor cells for collection, and treatment of documented neutropenia related to chemotherapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when administration or associated services require substantially greater resources than usual (e.g., complex patient counseling, prolonged observation for adverse reaction). |