Summary & Overview
HCPCS Level II C9136: Injection, Factor VIII Fc Fusion Protein (Recombinant)
HCPCS Level II code C9136 designates the per-unit billing for a recombinant factor VIII Fc fusion protein injection used in treating or preventing bleeding in individuals with factor VIII deficiency, including hemophilia A. This biologic represents a key class of extended-half-life clotting factors that affect clinical dosing intervals and infusion planning. Nationally, accurate reporting of HCPCS Level II code C9136 matters for clinical care continuity, reimbursement accuracy, and biologics inventory management across infusion settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context, expected site-of-service considerations, and the types of benchmarks and policy updates typically relevant to high-cost biologic injections. The publication outlines common billing considerations for per-unit dosing, payer coverage patterns, and coding interactions that affect claim adjudication.
This summary prepares clinicians, billing staff, and policy analysts to locate benchmarks, interpret recent policy notices affecting biologic clotting factors, and understand practical implications for outpatient infusion workflows. Data not provided in the input (for example, specific modifier usage, associated taxonomies, and ICD-10 pairings) is noted where applicable within the full publication.
Billing Code Overview
HCPCS Level II code C9136 represents an injection of factor VIII Fc fusion protein (recombinant), billed per international unit (I.U.). The service is a recombinant clotting factor administration used for treatment or prevention of bleeding in patients with hemophilia A or other factor VIII deficiency states.
Service Type: Therapeutic biologic injection / clotting factor replacement therapy
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or ambulatory infusion clinic
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a male with severe hemophilia A who requires replacement therapy with a recombinant factor VIII Fc fusion protein for prevention or control of bleeding. The patient arrives at an outpatient infusion center or hospital outpatient clinic for scheduled prophylactic or on-demand intravenous infusion. Pre-infusion workflow includes verification of identity, review of current weight and recent factor levels, assessment for inhibitors or allergic reactions, and checking the prescribed international units per kilogram. The infusion nurse prepares the product, confirms the C9136 billing code and dose in international units (I.U.), performs venous access (peripheral IV or established central line), administers the reconstituted product per institutional infusion protocol, and monitors the patient for infusion reactions for 30–60 minutes post-infusion. Documentation includes product lot number, total I.U. administered, infusion start and stop times, site of service (outpatient infusion center, clinic, or hospital outpatient department), indication, and any immediate adverse events. Care coordination may involve the hematologist, infusion nurse, pharmacy for drug preparation, and the billing/coding staff to submit claims to payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered to any patient |