Summary & Overview
HCPCS C9290: Injection, bupivacaine liposome, 1 mg
HCPCS Level II code C9290 denotes an injectable liposomal formulation of bupivacaine, billed per milligram as injection, bupivacaine liposome, 1 mg. The code identifies a long-acting local anesthetic option used for perioperative pain control and prolonged regional analgesia. Nationally, availability of liposomal bupivacaine formulations affects perioperative pain management strategies and can influence utilization patterns for ambulatory and inpatient surgical procedures.
Key payers considered 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 service settings (ambulatory surgical centers, hospital outpatient departments, and physician offices), and the clinical context for use. The publication summarizes benchmarks and coverage considerations observed across major national payers, notes coding and billing practice implications for service lines that administer extended-duration local anesthesia, and highlights areas where policy updates may affect reimbursement and prior authorization practices.
This analysis is intended for billing staff, clinical leaders, and policy analysts seeking a national perspective on use and coverage of HCPCS Level II code C9290. It does not provide clinical guidance or payer-specific claim instructions.
Billing Code Overview
HCPCS Level II code C9290 describes Injection, bupivacaine liposome, 1 mg. This code represents a single-dose injectable formulation of bupivacaine in a liposomal delivery system, used for prolonged local analgesia.
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Service type: Therapeutic local anesthetic injection for extended-duration pain control
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Typical site of service: Ambulatory surgical centers, hospital outpatient departments, and physician offices where local regional anesthesia or perioperative local infiltration is administered
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult undergoing a scheduled soft-tissue or surgical procedure (for example, bunionectomy, open inguinal hernia repair, or shoulder arthroscopy) requiring long-acting local analgesia at the operative site. The surgeon or anesthesiologist administers C9290 (injection, bupivacaine liposome, 1 mg) intraoperatively or immediately postoperatively as part of a multimodal analgesia plan to provide extended-duration local anesthesia and reduce opioid use. The workflow includes verification of indication and informed consent, preparation of the liposomal bupivacaine dose by a licensed clinician or pharmacy, aseptic infiltration into the surgical site or perineural space as documented in the operative or anesthesia record, monitoring in the post-anesthesia care unit for expected local anesthetic effects and potential adverse reactions, and documentation of dose administered, site of infiltration, lot number, and any immediate complications. Billing uses HCPCS Level II code C9290 with any applicable modifier(s) to reflect unusual circumstances, administrative requirements, or payer-specific rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to prepare or administer is substantially greater than usual and documented (e.g., complex infiltration in reoperative field). |