Summary & Overview
HCPCS C9140: Injection, Factor VIII (Afstyla), 1 I.U.
HCPCS Level II code C9140 represents the injectable recombinant factor VIII product Afstyla, billed per international unit (1 I.U.) for replacement therapy in hemophilia A. This code matters nationally because access to and coverage of recombinant clotting factors are central to the management of congenital hemophilia, affect high-cost drug spending, and influence care continuity for vulnerable patients requiring regular replacement therapy. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code denotes clinically and operationally, how it is used across infusion and outpatient settings, and which payers commonly cover the product. The publication provides benchmarks and payer coverage patterns, summarizes relevant policy and coding updates affecting biologic factor replacement billing, and offers clinical context for coding consistency and claims submission. Where specific input data were not provided, the text notes that those details are unavailable. The focus remains on national implications for billing, coverage, and service delivery for recombinant factor VIII therapy.
Billing Code Overview
HCPCS Level II code C9140 describes an injection of factor VIII (antihemophilic factor, recombinant) (afstyla), 1 I.U. The service is the administration of a recombinant factor VIII product used for replacement therapy in patients with hemophilia A.
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Service type: Injectable biologic replacement therapy
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Typical site of service: Hospital outpatient departments, infusion centers, and ambulatory care clinics where intravenous or subcutaneous biologic infusions are provided
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual with hemophilia A presenting for outpatient administration of recombinant antihemophilic factor VIII concentrate (C9140, afstyla) to prevent or treat bleeding. The clinical workflow begins with a hematology assessment documenting indication (on-demand treatment of bleeding episode, perioperative prophylaxis, or routine prophylactic infusion), determination of weight and desired international units (I.U.) dose, pharmacy preparation of the product vial(s) labeled in I.U., and verification of lot number and expiration. A registered nurse or trained infusion nurse performs venous access placement or uses an existing port, confirms patient identity and consent, verifies baseline vital signs and recent factor activity or inhibitor status if available, and administers the calculated dose intravenously per institutional infusion guidelines. Post-infusion monitoring for infusion reactions, allergic responses, thrombotic events, and efficacy (bleeding control or perioperative hemostasis) is completed with documentation of amount administered in I.U., time, lot number, and site. Typical sites of service include outpatient infusion centers, hospital outpatient departments, emergency departments for acute bleeding, ambulatory surgical centers for perioperative prophylaxis, and home infusion when clinically appropriate under a home health program.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service |