Summary & Overview
HCPCS C9142: Injection, bevacizumab-maly (Alymsys), 10 mg
HCPCS Level II code C9142 identifies the bevacizumab biosimilar product bevacizumab-maly (Alymsys) and is billed per 10 mg unit. As a biosimilar oncology biologic used in parenteral administration, this code matters nationally for oncology and ophthalmology practices that administer bevacizumab products, hospital outpatient infusion services, and payer coverage policies that distinguish innovator versus biosimilar biologics. Payers commonly referenced in coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This report provides readers with a concise clinical and billing profile of C9142, including expected service settings, the clinical context for bevacizumab biosimilars, and what to expect in payer coverage frameworks. Readers will find benchmarks for unit-based billing, summaries of how major payers approach biosimilar policy (coverage and coding considerations), and concise clinical context about bevacizumab use and administration. Data not available in the input will be clearly noted in relevant sections. The content is intended for clinicians, billing professionals, and policy analysts seeking a national-level reference on coding and service implications for the Alymsys biosimilar.
Billing Code Overview
HCPCS Level II code C9142 describes an injectable biosimilar medication: injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg. This code represents the specific product formulation and unit of measure for the bevacizumab biosimilar marketed as Alymsys, billed per 10 mg increment.
-
Service type: Parenteral infusion/injection of a biologic agent
-
Typical site of service: Hospital outpatient department, physician office, or ambulatory infusion center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusion (RVO)–related macular edema, or other off-label retinal vascular/neoplastic indications receiving an intravitreal injection of the bevacizumab biosimilar C9142 (bevacizumab-maly, 10 mg). The clinical workflow: patient presents to an ophthalmology clinic or ambulatory surgical center for evaluation; a retinal specialist documents visual acuity, intraocular pressure, and retinal exam with optical coherence tomography as indicated; informed consent is obtained; topical anesthesia and antisepsis are applied; the provider prepares the appropriate dose from the supplied vial or unit of C9142 and performs a sterile intravitreal injection; post-injection exam and discharge instructions are provided with planned follow-up or treat-and-extend scheduling.
Typical site of service: ophthalmology clinic procedure room, office-based procedure suite, or ambulatory surgical center.
Typical patient scenario: a 72-year-old patient with worsening central vision from nAMD despite prior anti-VEGF therapy is scheduled for intravitreal injection of C9142 in the affected eye with routine pre- and post-injection monitoring and scheduled follow-up in 4–6 weeks.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|