C9250 Fibrin Sealant HCPCS: Reimbursement & Policy

HCPCS Level II code C9250 denotes a 2 ml vial of human plasma fibrin sealant (Artiss), vapor-heated and solvent-detergent processed, used as a surgical hemostatic and tissue sealant. This biologic adjunct is applied during operative and procedural care to control bleeding and facilitate tissue adherence, making it relevant across surgical specialties including plastic, reconstructive, and general surgery.

Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how C9250 is classified for billing, summarizes payer coverage patterns, and highlights the clinical contexts in which the product is typically used.

Readers will find benchmarks for utilization and reimbursement structures, summaries of relevant payer policy themes, and clinical context for appropriate service lines and sites of service. The report also identifies common modifiers associated with procedural supply billing and notes gaps where data were not provided. This summary is intended for a national audience of billing professionals, revenue cycle managers, and surgical clinical leadership seeking concise guidance on the classification and billing context of HCPCS Level II code C9250.

Billing Code Overview

HCPCS Level II code C9250 represents human plasma fibrin sealant, vapor-heated, solvent-detergent (Artiss), 2 ml. This product is a biologic surgical hemostatic and tissue sealant derived from human plasma and prepared using vapor-heating and solvent-detergent processes.

Service Type: Surgical hemostatic/tissue adhesive application

Typical Site of Service: Operating room or procedural suite

Data not available in the input.

Clinical Context

A typical patient is an adult undergoing a surgical procedure—commonly dermatologic, plastic/reconstructive, head and neck, or orthopedic soft-tissue surgery—where meticulous hemostasis and tissue approximation are required. The product described, C9250 (human plasma fibrin sealant, vapor-heated, solvent-detergent, 2 ml; trade name Artiss), is used intraoperatively as a biologic adhesive and hemostatic adjunct to reduce bleeding, secure skin grafts or flaps, and promote tissue adherence.

A realistic scenario: A 62-year-old patient presents for Mohs micrographic surgery with a large full-thickness cheek defect that will be reconstructed with a local advancement flap and a split-thickness skin graft. After achieving primary hemostasis with electrocautery and sutures, the surgical team applies C9250 fibrin sealant to the graft bed to enhance graft take and limit postoperative hematoma. Use is performed in the operating room under monitored anesthesia care; nursing documents lot number, expiration, and amount used; the surgeon documents indication, application site, and clinical effect. The product is billed with C9250 and may be appended with appropriate modifiers reflecting service circumstances (for example, modifier 62 for co-surgery or modifier AS for physician assistant when applicable). Typical sites of service include the hospital operating room, ambulatory surgery center, and occasionally office-based procedure rooms for selected dermatologic surgeries.

Clinical workflow steps:

Preoperative: consent includes use of biologic adhesives and discussion of plasma-derived product.
Intraoperative: standard hemostasis achieved; C9250 prepared per manufacturer instructions; applied to graft or flap interface; allowed to set for recommended time before dressing and closure.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no special circumstances apply to the service.
`22`	Increased procedural services	Use when work required is substantially greater than usual (document rationale).
`23`	Unusual anesthesia	Use when procedure performed under general anesthesia due to medically necessary circumstances.
`51`	Multiple procedures	Use when `C9250` is billed on the same day as multiple surgical procedures and payer requires this modifier.
`52`	Reduced services	Use when the full service was not completed or was partially reduced.
`53`	Discontinued procedure	Use when the procedure was started but discontinued and `C9250` use relates to the discontinued service.
`54`	Surgical care only	Use when only the surgical portion is billed by the surgeon separate from pre/post care.
`55`	Postoperative management only	Use when only postoperative care is billed by the provider.
`56`	Preoperative management only	Use when only preoperative management is billed by the provider.
`62`	Two surgeons (co-surgery)	Use when two surgeons of different specialties perform distinct surgical services and `C9250` application is part of co-surgery.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an eligible advanced practitioner assists at surgery and payer allows billing with this modifier.
`JZ`	No device or no service furnished under certain DMEPOS	Rarely applied to drugs/biologics; include only if payer instruction specifically requires `JZ` for zero-cost items.
`QX`	CRNA service furnished under direction of a physician	Use when an independent CRNA furnishes anesthesia services relevant to the operative episode.
`QY`	Medical direction of two, three, or four concurrent anesthesia procedures	Use when anesthesia medical direction rules apply to the case.

Taxonomy Code	Specialty	Notes
`208D00000X`	General Surgery	Commonly performs tissue reconstruction and applies fibrin sealants.
`207L00000X`	Dermatology	Uses fibrin sealants in Mohs surgery and skin grafting procedures.
`2084P0800X`	Plastic Surgery	Frequent user for flap and graft adhesion and hemostasis.
`207XS0112X`	Otolaryngology (ENT)	Uses in head and neck reconstructions and mucosal grafts.
`207K00000X`	Orthopedic Surgery	Uses in soft-tissue repairs and tendon/skin graft adjuncts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S01.401A`	Laceration without foreign body of right cheek and temporomandibular area, initial encounter	Facial lacerations requiring repair and possible grafting where fibrin sealant aids hemostasis and adherence.
`C44.319`	Squamous cell carcinoma of skin of other parts of face	After tumor excision with reconstruction or grafting, fibrin sealant may be used to secure grafts and reduce bleeding.
`T81.0XXA`	Hemorrhage and hematoma complicating a procedure, initial encounter	Fibrin sealant is used intraoperatively to control bleeding and reduce postoperative hematoma risk.
`L98.9`	Disorder of the skin and subcutaneous tissue, unspecified	Broad category for wounds or defects where grafting and sealants may be applied.
`S81.811A`	Open wound, left lower leg, initial encounter	Traumatic soft-tissue defects repaired with grafts where fibrin sealant supports graft take.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`15271`	Skin graft, full-thickness; trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children	Often performed before application of fibrin sealant to secure the graft to the recipient site.
`15275`	Skin graft, full-thickness; face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 100 sq cm, or part thereof (List separately in addition to code for primary procedure)	Used in complex reconstructive cases that may require fibrin sealant adjunct.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap; trunk	Flap procedures where fibrin sealant is applied to reduce dead space and reinforce tissue adherence.
`12001`	Repair, simple wounds (e.g., 2.5 cm or less)	Minor closures where fibrin sealant may be used adjunctively in the same operative session.
`14060`	Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm to 30 sq cm	Reconstruction codes commonly billed in the same operative episode where `C9250` is used to support graft/flap adherence.
`66984`	Extracapsular cataract removal with insertion of intraocular lens (complex)	Example of a separate specialty procedure where fibrin sealant formulations may be used in ophthalmologic surgery for wound sealing (selected when clinically applicable).

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Summary & Overview

HCPCS C9250: Human Plasma Fibrin Sealant (Artiss), 2 ml