C9167 ADAMTS13 Injection Reimbursement

HCPCS Level II code C9167 denotes an injection of recombinant ADAMTS13 (recombinant-krhn), packaged per 10 international units. This biologic therapy is used to replace or supplement ADAMTS13 activity and has significance for rare hematologic conditions where enzyme replacement is clinically indicated. National attention centers on access to high-cost biologics, appropriate site-of-care utilization, and payer coverage policies for novel recombinant therapies.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes payer coverage patterns, expected service settings, clinical context, and considerations for billing and claims adjudication related to a stabilized biotherapeutic injection.

Readers will find benchmarks on where this service is typically administered (hospital inpatient, outpatient infusion centers, emergency departments, and clinic-based injection suites), an overview of billing considerations tied to HCPCS Level II coding, and a concise clinical context explaining the therapeutic role of ADAMTS13 replacement. Where specific payer policy details, taxonomies, or ICD-10 linkage data are not provided in the input, the publication notes that such data are not available and focuses on the code definition, service type, and national policy relevance instead.

Billing Code Overview

HCPCS Level II code C9167 represents an injection of recombinant ADAMTS13 (recombinant-krhn), dosed per 10 international units. The code describes a biologic replacement therapy administered via parenteral injection intended to provide ADAMTS13 activity.

Service Type: Therapeutic injection (biologic replacement therapy)

Typical Site of Service: Hospital inpatient or outpatient infusion/administration setting, emergency department, or clinic-based injection suite, depending on clinical need and local practice patterns.

Data not available in the input.

Clinical Context

A typical patient is an adult or adolescent diagnosed with immune-mediated thrombotic thrombocytopenic purpura (iTTP) presenting with acute thrombocytopenia, microangiopathic hemolytic anemia, and organ ischemia (neurologic symptoms, renal dysfunction, or cardiac ischemia). The treating clinician assesses ADAMTS13 deficiency and inhibitory antibodies; while plasma exchange and immunosuppression are standard, administration of recombinant ADAMTS13 (C9167 — Injection, adamts13, recombinant-krhn, 10 IU) may be ordered in a hospital inpatient or outpatient infusion center as part of replacement therapy.

Typical workflow: initial hematology consult, laboratory confirmation of severe ADAMTS13 deficiency, placement of intravenous access, review of concurrent therapies (plasma exchange, corticosteroids, rituximab), preparation and verification of the recombinant ADAMTS13 dose by pharmacy, administration via IV infusion in the inpatient bed or outpatient infusion suite, monitoring for infusion reactions and clinical response, documentation of dose, lot number, and patient tolerance, and follow-up hematology assessments to guide further dosing and adjunctive therapy.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when administration requires substantially greater resources than typical (e.g., complicated access, prolonged monitoring).

Taxonomy Code	Specialty	Notes
`2080P0200X`	Hematology	Hematologists most commonly evaluate and direct therapy for iTTP and ADAMTS13 replacement.
`208D00000X`	Medical Oncology	Oncology/hematology practices may administer infusion therapies and coordinate complex immunosuppression.
`363LA2200X`	Clinical Laboratory	Clinical laboratory specialists perform ADAMTS13 testing and coordinate specimen handling relevant to therapy.
`3336C0002X`	Infusion Therapy	Infusion center clinicians and nurses perform preparation and administration of biologic infusions.
`363A00000X`	Pathology-Anatomic & Clinical	Pathologists may oversee diagnostic testing and interpretation of hemolysis markers that guide therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D69.59`	Other secondary thrombocytopenia	Reflects thrombocytopenia due to acquired causes where ADAMTS13 replacement may be indicated.
`D69.49`	Other hemorrhagic conditions	Used for microangiopathic processes associated with ADAMTS13 deficiency when more specific codes are not applicable.
`M31.9`	Systemic vasculitis, unspecified	Included when vasculitic microangiopathy contributes to thrombotic microangiopathy requiring ADAMTS13 therapy.
`I82.40`	Acute embolism and thrombosis of unspecified deep veins of lower extremity	Represents thrombotic complications that can co-occur with severe ADAMTS13 deficiency.
`R79.0`	Abnormal level of bilirubin	Reflects hemolysis and hepatic conversion related to microangiopathic hemolytic anemia in iTTP.
`N17.9`	Acute kidney failure, unspecified	Renal dysfunction is a common organ involvement in thrombotic microangiopathy prompting ADAMTS13 therapy.
`G94`	Other and unspecified disorders of brain in diseases classified elsewhere	Neurologic ischemia or encephalopathy related to microthrombi where ADAMTS13 replacement is clinically relevant.
`D59.3`	Drug-induced autoimmune hemolytic anemia	Included when hemolysis associated with immune processes and ADAMTS13 modulation is part of the treatment plan.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Venous access for laboratory monitoring before and after recombinant ADAMTS13 administration.
`36430`	Blood transfusion, specifying non-therapeutic methods (peripheral IV infusion)	Use for IV administration procedures in an infusion setting when billing infusion-related services; supports IV access for biologic administration.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Common code for billing the initial therapeutic infusion session of a biologic agent such as recombinant ADAMTS13.
`96366`	Intravenous infusion, each additional hour	Use when infusion of the biologic extends beyond the first hour.
`96372`	Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular)	Use if small bolus injections or subcutaneous supportive therapies are given in conjunction with the IV infusion.
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit	Use for specialized infusion supplies, biologic-specific disposables, or administration kits required for `C9167`.

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Summary & Overview

HCPCS Level II C9167: Injection, recombinant ADAMTS13, 10 IU