Summary & Overview
HCPCS C9144: Injection, bupivacaine (posimir), 1 mg
HCPCS Level II code C9144 denotes an injectable formulation of bupivacaine (posimir), billed per 1 mg. This code represents administration of a long-acting local anesthetic used for targeted pain control and regional anesthesia, increasingly relevant as extended-release local anesthetic products enter clinical practice. Nationally, clear coding for such agents affects claims processing, coverage determinations, and utilization tracking across care settings where injections are performed.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, coding and billing benchmarks, and clinical context for use of extended-release bupivacaine formulations.
Readers will learn: (1) the clinical indication and typical sites of service for C9144; (2) billing considerations and common modifiers used with injectable local anesthetics; (3) benchmarking and reimbursement context across major national payers; and (4) policy and coverage trends affecting extended-release anesthetic products. Data not available in the input will be noted where relevant. This summary provides a concise reference for coders, practice managers, and policy analysts handling claims for C9144.
Billing Code Overview
HCPCS Level II code C9144 describes an injection of bupivacaine (posimir) dosed per 1 mg. The service is an injectable local anesthetic administration intended for pain management or regional anesthesia. Typical site of service is ambulatory surgical centers, hospital outpatient departments, or physician offices where injectable local anesthetic procedures are performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with focal postoperative or chronic localized pain in a superficial surgical site or soft-tissue location (for example, sternal wound, shoulder/axillary soft tissue, or superficial extremity incision) where a long-acting local anesthetic implant is indicated for prolonged analgesia. The patient is evaluated in a perioperative or ambulatory procedure setting (same-day surgery or hospital outpatient). The clinician (often an anesthesiologist, pain medicine physician, or surgeon) reviews the indication, allergies, and coagulation status, obtains informed consent, and performs aseptic preparation of the site. Under direct visualization during the surgical procedure or in a procedure room, the clinician injects the indicated dose of a bupivacaine implant product (C9144 corresponds to bupivacaine (posimir), 1 mg) into the targeted soft tissue plane or wound bed for sustained postoperative analgesia. Typical monitoring includes standard vital signs, observation for local anesthetic systemic toxicity, and wound assessment. The patient is discharged per institutional protocols with instructions for pain control and signs/symptoms that require urgent evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when work required is substantially greater than typical for this procedure (document rationale). |
52 | Reduced Services | Use when the procedure is partially reduced or not completed as documented.
53 | Discontinued Procedure | Use when the procedure is terminated due to unforeseen circumstances after initiation.
62 | Two Surgeons | Use when two surgeons with different specialties work together as primary surgeons.
AS | Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist | Use when services are performed in whole or part by these nonphysician practitioners (state-specific payer rules apply).
LT | Left Side | Use when laterality is required by payer for the documented injection site on the left.
RT | Right Side | Use when laterality is required by payer for the documented injection site on the right.
QK | Medical Direction of Two, Three, or Four CRNAs by a Physician | Use when a physician medically directs multiple CRNAs involved in anesthesia care.
QX | CRNA Service with Personal AANA-Certified CRNA | Use to identify services furnished by a CRNA when required for billing.
QY | Medical Direction by a Physician of One CRNA | Use when physician medical direction of one CRNA is documented.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2084P0800X | Pain Medicine | Common specialty performing wound-targeted long-acting local anesthetic implants. |
207L00000X | Anesthesiology | Frequently places long-acting local anesthetic at time of surgery for postoperative analgesia.
207P00000X | Surgery | General surgeons or surgical subspecialists place implantable local anesthetic at wound closure.
363A00000X | Nurse Anesthetist | CRNAs may be involved in administration under supervision or by protocol.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M79.602 | Pain in right arm | Localized postoperative or traumatic soft-tissue pain where a bupivacaine implant may be used for prolonged analgesia. |
M79.601 | Pain in left arm | Left-sided localized pain that may be addressed with a wound-directed long-acting local anesthetic.
G89.18 | Other acute pain | Acute postoperative pain requiring enhanced local analgesic measures.
G89.29 | Other chronic pain | Chronic localized pain conditions in which prolonged local anesthetic delivery could be considered in select cases.
T81.89XA | Other complications of procedure, initial encounter | Used if complications related to the procedure or implant occur and need coding.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
64450 | Injection, anesthetic agent; other peripheral nerve (e.g., intercostal, ilioinguinal, iliohypogastric) | Peripheral nerve injections for regional analgesia may be performed in conjunction with local implant for broader pain control. |
20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee); without ultrasound guidance | Joint or bursal injections for concurrent pain sources during the same encounter.
20550 | Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia") | Soft-tissue injections for localized non-surgical pain conditions that may use long-acting anesthetic techniques.
64483 | Injection(s), anesthetic agent and/or steroid; lumbar plexus (including imaging guidance) | Regional blocks performed perioperatively for enhanced analgesia alongside local implant placement.
99223 | Initial hospital care, typically 70 minutes or more, per day, for the evaluation and management of a patient | High-acuity inpatient evaluation when the implant is used in hospitalized surgical patients requiring global management.