Summary & Overview
HCPCS C9101: Injection, oliceridine, 0.1 mg
HCPCS Level II code C9101 denotes a 0.1 mg unit of oliceridine delivered by injection. Oliceridine is an intravenous opioid-analgesic used for management of acute severe pain where rapid parenteral analgesia is indicated. As a HCPCS Level II code, C9101 identifies the specific drug dosage unit for billing of injectable oliceridine separate from administration services. Nationally, accurate coding for intravenous analgesics matters for clinical documentation, prior authorization workflows, and pharmacy benefit adjudication.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what C9101 represents clinically and operationally, a summary of common modifiers used with this code, payer considerations and coverage patterns, and related administrative details such as typical sites of service and service line implications. The publication provides benchmarks for billing and utilization where available, notes on policy updates affecting injectable opioid coding, and context for coding teams and pharmacy billing staff on how this HCPCS Level II drug code fits into broader inpatient and outpatient analgesia workflows.
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Billing Code Overview
HCPCS Level II code C9101 represents Injection, oliceridine, 0.1 mg. This code describes a parenteral medication dose of oliceridine, an intravenous opioid-analgesic formulation, with the unit defined as 0.1 mg.
Service Type: Injectable medication administration (intravenous/parenteral) for analgesia
Typical Site of Service: Hospital inpatient or outpatient settings, emergency department, and procedural suites where parenteral opioid analgesia is administered.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult inpatient or outpatient undergoing management of moderate to severe acute pain after major surgery (for example, abdominal, orthopedic, or thoracic procedures) or with acute painful conditions in the emergency department where intravenous opioid analgesia is indicated. The clinician prepares and administers C9101 (injection, oliceridine, 0.1 mg) as part of an IV opioid analgesia protocol. Workflow steps include patient assessment for opioid eligibility and contraindications, verification of orders and dosing, IV access confirmation, administration by a qualified clinician (anesthesiologist, emergency physician, hospitalist, or trained registered nurse under protocol), monitoring for efficacy and adverse effects (respiratory depression, hypotension, nausea), documentation of dose, site of service, and any modifier-level circumstances (for example, concurrent anesthesia or discontinued procedure). Typical sites of service include hospital inpatient units, post-anesthesia care units, ambulatory surgery centers, and emergency departments. Patient-specific considerations include opioid tolerance, comorbid respiratory disease, concurrent sedatives, and renal or hepatic impairment that may affect monitoring and dosing decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard billing | Use for routine administration with no special circumstance modifiers applicable |