Summary & Overview
HCPCS C9447: Phenylephrine and Ketorolac Injection, 4 ml Vial
HCPCS Level II code C9447 designates an injection containing phenylephrine and ketorolac in a 4 ml vial, used as an intraoperative pharmacologic adjunct to provide vasoconstriction and anti-inflammatory/analgesic effects. Nationally, clear coding of combination pharmacologic products matters for accurate medical billing, appropriate reimbursement, and tracking of perioperative medication utilization.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the combined phenylephrine-ketorolac injection, typical sites of service (operating room and ambulatory surgery centers), and common billing considerations tied to HCPCS Level II reporting. The publication outlines benchmarks and coverage touchpoints relevant to institutional and professional billing, notes areas where coding clarity affects claims processing, and summarizes policy updates or guidance that commonly influence payer adjudication of injectable combination products.
The document is intended to help coding professionals, billing managers, and surgical services leaders understand how C9447 is used in clinical workflows, what to expect from major payers, and which aspects of documentation and charge capture most directly affect successful claim submission.
Billing Code Overview
HCPCS Level II code C9447 represents an injection formulation combining phenylephrine and ketorolac supplied as a 4 ml vial. This code identifies a pharmacologic intraoperative agent used to provide both vasoconstriction (phenylephrine) and nonsteroidal anti-inflammatory analgesia (ketorolac) during procedures.
Service Type: Injection — intraoperative pharmacologic adjunct
Typical Site of Service: Operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult undergoing cataract extraction with phacoemulsification and intraocular lens implantation who receives an intracameral injection of a combined phenylephrine and ketorolac formulation (C9447) to maintain pupillary dilation and reduce intraoperative miosis and postoperative pain/inflammation. The workflow includes preoperative evaluation by the ophthalmic surgeon, topical anesthesia and dilation in the preop area, routine sterile preparation in the OR or ambulatory surgery center, instillation of the C9447 4 ml vial into the anterior chamber per the manufacturer's instructions by the surgeon or licensed practitioner immediately prior to or during lens removal, and standard postoperative monitoring in the recovery area. Typical site of service is an ambulatory surgical center or hospital outpatient department for cataract surgery. Patient scenario: a 72-year-old with visually significant cataract, planned phacoemulsification/PCIOL, history of intraoperative floppy iris syndrome risk factors (e.g., alpha-blocker use) or small pupil; the surgeon uses C9447 intraoperatively to maintain dilation and mitigate inflammation and pain, documented in operative note and medication administration record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 |