Summary & Overview
HCPCS C9451: Peramivir Injection, 1 mg
HCPCS Level II code C9451 denotes a per-milligram unit of the antiviral injection peramivir (1 mg). As an HCPCS Level II drug supply code, it is used to bill for administered peramivir doses across acute care settings where intravenous antivirals are provided. Nationally, peramivir billing matters for hospitals and emergency departments managing severe influenza and other viral illnesses requiring parenteral antiviral therapy, affecting inpatient drug spend and outpatient infusion reimbursement.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical role and billing context, typical sites of service, and the types of benchmarks and policy topics commonly associated with HCPCS drug codes: reimbursement benchmarks, payer coverage patterns, billing documentation expectations, and relevant coding crosswalks.
The publication provides practical reference points for revenue cycle, pharmacy, and clinical leaders to understand where C9451 fits in drug administration workflows, what payers typically influence coverage and payment, and which operational areas—such as dose documentation and infusion setting—drive correct usage. Data not available in the input.
Billing Code Overview
HCPCS Level II code C9451 represents Injection, peramivir, 1 mg. This code is used to report administration of the antiviral medication peramivir in a quantified unit of 1 mg.
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Service type: Drug administration (intravenous antiviral injection)
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Typical site of service: Hospital inpatient or outpatient settings, emergency department, and other acute care facilities where intravenous antiviral therapy is provided.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient infusion center, emergency department, or hospital with confirmed or strongly suspected acute influenza infection, especially high-risk individuals (eg, elderly, immunocompromised, pregnant patients, or those with chronic cardiopulmonary disease) who are unable to tolerate or absorb oral antivirals. Peramivir is administered as an intravenous antiviral agent dosed in milligrams. The clinical workflow includes initial triage and assessment, confirmation of influenza by rapid antigen test or PCR, review of indications and contraindications, IV access placement, preparation of the medication, administration of the C9451 billed item (peramivir, 1 mg), post‑administration monitoring for infusion reactions, documentation of dose, lot number and route, and discharge or admission planning. Typical sites of service include outpatient infusion centers, emergency departments, observation units, and inpatient wards when oral or inhaled therapy is not feasible.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by same physician on same day | Use when a separate E/M visit is performed and documented on the same day as the IV peramivir administration |