Summary & Overview
HCPCS C9147: Injection, tremelimumab-actl, 1 mg
HCPCS Level II code C9147 designates the injectable biologic product tremelimumab-actl, billed per 1 mg. As a drug-specific HCPCS Level II code, C9147 matters nationally for hospitals, oncology clinics, and infusion centers managing billing and coverage for novel immunotherapy agents. Accurate use of this code impacts provider reimbursement, patient cost-sharing, and payer formulary management.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what C9147 represents clinically and operationally, how major payers commonly approach coverage and prior authorization for high-cost oncology biologics, and where to look for coding and billing variations. The publication summarizes available benchmarks, common billing practices, and recent policy updates that affect administration and reimbursement of injectable monoclonal antibodies.
The report also situates C9147 in clinical context—used during outpatient infusion encounters—and outlines expected service settings and billing considerations. Data not included in the input (for example, diagnosis mappings, per-payer rates, and utilization statistics) are noted as unavailable where relevant.
Billing Code Overview
HCPCS Level II code C9147 represents Injection, tremelimumab-actl, 1 mg. This code denotes administration of the monoclonal antibody tremelimumab-actl measured per milligram and is used to bill for the drug product itself when provided in an outpatient or infusion setting.
Service Type: Drug administration (injectable biologic)
Typical Site of Service: Hospital outpatient infusion center or ambulatory infusion clinic
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient with advanced unresectable melanoma presents for systemic immunotherapy. The oncology team prescribes tremelimumab-actl administered as an intravenous infusion with dosing prepared based on weight or fixed dose; the pharmacy dispenses the drug and the infusion center documents administration. The typical workflow includes pre-infusion nursing assessment (vital signs, allergy check), verification of informed consent, verification of the product C9147 (injection, tremelimumab-actl, 1 mg) and dose calculation, premixing in an appropriate diluent under sterile technique by pharmacy, infusion via peripheral or central IV access by infusion nursing, monitoring for infusion reactions during and after administration, and documentation of dose, lot number, administration site, and any adverse events. Post-infusion follow-up includes clinic or telehealth assessment for immune-related adverse events and coordination of subsequent cycles per the oncology treatment plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when administration requires substantially greater effort or complexity than typical (document rationale). |
23 |