Summary & Overview
HCPCS Level II C9097: Injection, faricimab-svoa, 0.1 mg
HCPCS Level II code C9097 denotes a 0.1 mg injection of faricimab-svoa, an intravitreal biologic therapy used in retinal disease management. As a newly codified HCPCS Level II code for a specific biologic ophthalmic product, C9097 standardizes reporting for product-specific dosing and supports accurate billing, utilization tracking, and payer coverage determinations nationwide.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The code is relevant to ophthalmology practices, ambulatory surgical centers, and outpatient clinics that administer intravitreal injections.
Readers will find a concise explanation of the code’s clinical meaning, typical sites of service, and the payer landscape addressed in this publication. The content includes benchmarks and coverage considerations for major national payers, high-level policy updates affecting HCPCS coding for biologics in ophthalmology, and clinical context around intravitreal administration of faricimab-svoa. Where input data is incomplete, the publication notes missing fields and focuses on available information to inform billing accuracy and payer communication nationally.
Billing Code Overview
HCPCS Level II code C9097 represents Injection, faricimab-svoa, 0.1 mg. This code describes administration of a 0.1 mg dose of faricimab-svoa, an intravitreal biologic therapy used in ophthalmology for retinal vascular conditions.
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Service type: Intravitreal injection
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Typical site of service: Ophthalmology clinic, outpatient ambulatory surgical center, or physician office for intravitreal procedures
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Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with neovascular (wet) age-related macular degeneration presents for intravitreal therapy. The ophthalmologist documents decreased central vision, metamorphopsia on Amsler grid, and optical coherence tomography (OCT) demonstrating intraretinal and subretinal fluid consistent with active choroidal neovascularization. After review of prior treatments and obtaining informed consent, the clinic schedules an intravitreal injection of C9097 (inj, faricimab-svoa, 0.1 mg). Typical workflow includes pre-procedure visual acuity and intraocular pressure checks, topical antisepsis and anesthesia, administration of the intravitreal anti-VEGF agent in a procedure room or minor treatment area, post-injection pressure check and drop administration, and documentation of lot number and eye injected. The typical site of service is an outpatient ophthalmology clinic or ambulatory procedure suite equipped for minor ophthalmic procedures. Common patient follow-up includes same-day post-procedure instructions and a return visit in 4–6 weeks for re-evaluation and possible repeat injection based on disease activity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to administer the injection is substantially greater than usual (rare for standard intravitreal injections). |