Summary & Overview
HCPCS C9152: Aripiprazole Injection (Abilify Asimtufii), 1 mg
HCPCS Level II code C9152 designates the injectable formulation of aripiprazole (Abilify Asimtufii), billed per 1 mg unit. This code matters nationally as aripiprazole injections are used in the management of psychiatric disorders and can drive pharmacy-administered medication costs in outpatient behavioral health settings. Clear coding supports accurate pharmacy billing, payer coverage determinations, and utilization monitoring for antipsychotic injectable therapy.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, typical sites of service, and the clinical context for use. The publication provides benchmarks and operational guidance on common modifier usage and payer interactions where available, and it highlights policy updates that affect coverage and billing for injectable antipsychotic medications. Clinical context outlines that this code applies to parenteral administration of aripiprazole, typically in outpatient or ambulatory settings. Where specific data inputs were not provided, the text notes that information is not available in the input. The piece is designed for revenue cycle, clinical leaders, and policy analysts seeking a national-level summary of billing implications and operational considerations for HCPCS Level II code C9152.
Billing Code Overview
HCPCS Level II code C9152 describes an injectable formulation of aripiprazole (Abilify Asimtufii), 1 mg. The service represents a pharmaceutical injectable medication administration product line for a long-acting or repeat-dose antipsychotic agent formulated for parenteral use.
Service Type: Injection — antipsychotic medication
Typical Site of Service: Outpatient clinics, physician offices, behavioral health clinics, and ambulatory infusion centers
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with schizophrenia or bipolar disorder presents for a scheduled long-acting injectable antipsychotic administration. The medication billed with C9152 is aripiprazole (Abilify Asimtufii) provided as an injectable formulation dosed per milligram; the encounter typically occurs in an outpatient behavioral health clinic, psychiatric infusion suite, community mental health center, or physician office with trained nursing staff. The workflow includes medication verification, review of recent psychiatric status and adverse effects, assessment for injection-site contraindications, obtaining informed consent, medication reconstitution or syringe preparation per manufacturer instructions, and administration via intramuscular injection. Post-injection monitoring for immediate adverse reactions (typically 15–30 minutes) is performed and documented. Billing uses C9152 to report the quantity of aripiprazole in milligrams administered; appropriate visit or administration level CPT codes may be billed separately. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA plans, and Medicare, each with specific coverage and prior authorization rules for long-acting injectable antipsychotics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |