Summary & Overview
HCPCS C9158: Injection, risperidone (Uzedy), 1 mg
HCPCS Level II code C9158 designates the injection of risperidone (Uzedy), 1 mg. As an HCPCS Level II drug code, it identifies a specific unit of a specialty injectable antipsychotic used in outpatient settings where clinicians administer long-acting or specialty medications. Nationally, standardized coding for injectable psychotropic agents matters for claims processing, benefit design, and monitoring specialty drug utilization.
Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement practices for HCPCS drug codes can affect site-of-care decisions, prior authorization requirements, and patient cost-sharing for injectables.
Readers will find a concise overview of what C9158 represents clinically and operationally, a summary of common payer considerations, and guidance on where to locate further billing and policy details. The publication highlights benchmarks and policy updates relevant to HCPCS drug coding, clinical context for risperidone injections, and administrative issues such as coding consistency and site-of-service implications. Data not available in the input is noted where specifics (such as payer rates, taxonomies, or ICD-10 pairings) are not provided.
Billing Code Overview
HCPCS Level II code C9158 represents injection, risperidone (uzedy), 1 mg. This code describes the billed service for the administration of a 1 mg dose of risperidone in its Uzedy formulation. The service type is an injectable antipsychotic medication administration, and the typical site of service is an outpatient clinic, physician office, or infusion/medication administration center where long-acting or specialty injectable medications are provided.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with schizophrenia or schizoaffective disorder who is receiving long-acting injectable risperidone (brand: Uzedy) for maintenance therapy to improve adherence and reduce relapse. The patient presents to an outpatient behavioral health clinic, community mental health center, or hospital outpatient infusion/medication administration area for scheduled intramuscular injection. Initial workflow includes verification of identity and consent, review of current medications and recent symptoms, assessment for contraindications (allergy, pregnancy, current QT-prolonging medications), and measurement of vital signs. The clinician documents indication, dose (number of milligrams administered), lot number, expiration date, and injection site, performs the Uzedy intramuscular injection using aseptic technique, monitors the patient for 15–30 minutes for acute adverse reactions, and documents post-injection status and follow-up plan. Typical sites of service are outpatient clinic, mental health center, or hospital outpatient department. Billing uses HCPCS Level II code C9158 to report the administered drug amount per 1 mg unit, with appropriate units reported based on the milligrams given.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |