Summary & Overview
HCPCS Level II C9306: Injection, telisotuzumab vedotin-tllv, 1 mg
HCPCS Level II code C9306 designates the injectable oncology agent telisotuzumab vedotin-tllv at a unit measure of 1 mg. As a new, targeted antibody-drug conjugate, the code matters nationally because it standardizes billing for a specialty infusion product used in clinical oncology care and enables consistent reporting for payer coverage, utilization tracking, and reimbursement. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical and billing context for C9306, including the drug unit definition, expected site-of-service patterns, common modifiers used in practice, and where to find related coding and reimbursement resources. The publication outlines national benchmark considerations for infusion-administered oncology drugs, highlights payer coverage landscape at a high level, and summarizes documentation elements typically required to support medical necessity. Data not available in the input will be noted explicitly where applicable, and the content focuses on national policy and operational implications rather than state-specific guidance.
Billing Code Overview
HCPCS Level II code C9306 represents the drug administration descriptor Injection, telisotuzumab vedotin-tllv, 1 mg. The service type is drug administration / oncology infusion, reflecting use of a targeted antibody-drug conjugate delivered by injection. The typical site of service is hospital outpatient infusion center or ambulatory infusion clinic, consistent with parenteral oncologic therapies administered under clinical supervision.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced or metastatic non–small cell lung cancer (NSCLC) whose tumor testing demonstrates MET exon 14 skipping mutation or MET amplification and who has progressed on or is intolerant to prior systemic therapies. The patient presents to an oncology infusion center for administration of targeted antibody–drug conjugate therapy. The clinical workflow includes chemotherapy treatment planning by a medical oncologist, verification of identity and consent, medication order entry in the electronic health record specifying C9306 (telisotuzumab vedotin-tllv) dose in milligrams, pharmacy compounding and verification, bedside administration via intravenous infusion by an oncology nurse, pre‑ and post‑infusion monitoring for infusion reactions and adverse events, documentation of drug lot number and amount administered, and billing of the single‑ingredient HCPCS Level II code C9306 per milligram delivered. Typical sites of service are outpatient hospital infusion centers, physician office infusion suites, and freestanding infusion clinics. Patient monitoring commonly includes vital signs, assessment for hypersensitivity, and periodic oncology follow‑up visits to assess response and toxicity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | Use when a reduced dose or abbreviated administration occurs that meets payer rules for reduced service reporting. |