Summary & Overview
HCPCS C9275: Hexaminolevulinate Injection, 100 mg, Per Study Dose
HCPCS Level II code C9275 denotes an injection of hexaminolevulinate hydrochloride, 100 mg, billed per study dose for use as an intravesical diagnostic agent to enhance visualization during bladder imaging and endoscopic procedures. Nationally, the code matters because it captures use of a specialized diagnostic adjunct that can affect procedure coding, resource planning, and payer coverage determinations for urologic diagnostic services. Key payers typically addressed in coverage and reimbursement analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare (UHC), and Medicare. This publication provides a concise overview of the clinical context for C9275, the typical sites of service where the injection is administered, and the types of procedures with which the product is associated. Readers will find benchmarks and policy-relevant items such as common billing considerations, payer coverage patterns (where available), coding relationships to related procedural codes, and operational implications for outpatient and ambulatory settings. Data not available in the input is noted where applicable; the focus is on describing the code’s clinical purpose, service delivery setting, and payer landscape for national audiences.
Billing Code Overview
HCPCS Level II code C9275 represents an injection formulation of hexaminolevulinate hydrochloride, billed per study dose of 100 mg. This agent is used as an intravesical contrast or diagnostic adjunct to enhance visualization during bladder imaging or endoscopic evaluation.
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Service type: Diagnostic intravesical injection for bladder imaging/enhanced endoscopic visualization
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Typical site of service: Outpatient hospital or ambulatory surgical center, cystoscopy suite, or other endoscopy-capable outpatient clinic
Clinical & Coding Specifications
Clinical Context
A 68-year-old man with a history of recurrent non-muscle invasive bladder cancer presents to the urology clinic for cystoscopic evaluation and blue light cystoscopy using hexaminolevulinate. Prior urine cytology was suspicious and prior white-light cystoscopy identified a papillary lesion. The patient is consented for cystoscopy with instillation of C9275 (Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose) to enhance tumor visualization. In the procedure suite the sterile preparation is performed, the hexaminolevulinate solution is instilled into the bladder and retained for the recommended dwell time, then the patient is positioned for rigid or flexible cystoscopy. Under blue light illumination, additional lesions are identified that were occult on white light; targeted biopsies and/or transurethral resection of bladder tumor (TURBT) are performed as indicated. The workflow includes documentation of the product lot number and dose, the instillation and dwell time, the cystoscopic findings under both white and blue light, biopsies or resections performed, and specimen labeling for pathology. Post-procedure recovery instructions and follow-up surveillance scheduling are completed prior to discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service on the same day | When a distinct E/M visit is provided on the same day as the cystoscopy and instillation |