C9452 HCPCS Reimbursement & Policy Benchmarks

HCPCS Level II code C9452 designates the injectable drug product containing ceftolozane 50 mg combined with tazobactam 25 mg. This code is used to bill for the specific antibiotic formulation when administered in clinical settings. Nationally, accurate coding for branded and combination antimicrobials matters for inventory management, payer coverage determinations, and hospital drug cost reporting.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, typical sites of service where the product is administered, and the payer landscape relevant to reimbursement and coverage patterns. The publication summarizes benchmarks and policy considerations that affect billing and payment for specialty injectable antibiotics, highlights common billing pitfalls, and outlines the clinical scenarios in which ceftolozane–tazobactam is typically used.

The content provides operational guidance on what to expect when documenting and coding for this injectable product, clarifies where to find additional coding references, and identifies areas where payers often require prior authorization or specific documentation. Data not available in the input will be noted as such in the detailed sections.

Billing Code Overview

HCPCS Level II code C9452 describes the injection formulation combining ceftolozane 50 mg and tazobactam 25 mg. This code represents the billed supply or drug product for administration of the ceftolozane–tazobactam combination.

Service Type: Drug administration / injectable antibiotic product

Typical Site of Service: Hospital inpatient or outpatient infusion center, emergency department, or other facility-based infusion setting

Data not available in the input.

Clinical Context

A typical patient is an adult hospitalized with a complicated intra-abdominal infection or complicated urinary tract infection caused by multidrug-resistant Gram-negative organisms. The patient presents with fever, leukocytosis, and signs of systemic infection and has failed empiric therapy or culture results show pathogens susceptible to ceftolozane/tazobactam. The medication C9452 (injection, ceftolozane 50 mg and tazobactam 25 mg) is administered intravenously by the inpatient nursing team or infusion center pharmacy under a physician or infectious disease specialist order. The clinical workflow includes verification of culture and susceptibility data, renal function assessment to determine dose adjustment, pharmacy compounding of the IV infusion, administration over the required infusion time, monitoring for allergic reactions and infusion-related adverse events, and documentation of dose, lot number, and administration site in the medical record. Therapy duration is determined by the treating clinician based on infection type, clinical response, and infectious disease guidance.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when an E/M visit is performed on the same day as administration and is distinct from the infusion management.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Infectious Disease	Specialists who typically direct use of ceftolozane/tazobactam for resistant infections.
`207L00000X`	Internal Medicine	Hospitalists and internists who order and manage inpatient antimicrobial therapy.
`163W00000X`	Emergency Medicine	Emergency physicians who may initiate empiric therapy prior to admission.
`364S00000X`	Pharmacy	Clinical pharmacists who compound, dose-adjust, and verify IV antimicrobial therapy.
`174400000X`	Critical Care Medicine	Intensivists managing patients in ICU receiving broad-spectrum IV antibiotics.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A41.9`	Sepsis, unspecified organism	Sepsis is an indication for broad-spectrum IV antibiotics such as ceftolozane/tazobactam when Gram-negative pathogens are suspected.
`K35.80`	Acute appendicitis, unspecified with generalized peritonitis	Complicated intra-abdominal infections often require IV broad-spectrum agents targeting resistant Gram-negatives.
`K65.9`	Peritonitis, unspecified	Intra-abdominal infections and peritonitis may require coverage with ceftolozane/tazobactam for resistant organisms.
`N10`	Acute pyelonephritis	Complicated urinary tract infections and pyelonephritis from resistant Gram-negative bacilli can be treated with this agent.
`J15.9`	Unspecified bacterial pneumonia	Hospital-acquired or ventilator-associated pneumonias caused by resistant Gram-negative organisms may prompt use of ceftolozane/tazobactam.
`B96.2`	Klebsiella pneumoniae as the cause of diseases classified elsewhere	Identification of specific Gram-negative pathogens guides use of targeted agents like ceftolozane/tazobactam.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used to report the initial IV infusion encounter for administration of ceftolozane/tazobactam when infusion time is under or up to one hour as applicable.
`96366`	Intravenous infusion, each additional hour (List separately in addition to code for primary infusion)	Used when the infusion of the medication extends beyond the initial hour and requires reporting of additional infusion time.
`96367`	Intravenous infusion, each additional sequential infusion of a new drug, up to 1 hour	Used if a separate, sequential IV antimicrobial is administered during the same visit.
`36415`	Collection of venous blood by venipuncture	Used for pre-therapy laboratory monitoring (e.g., renal function, cultures) required before or during therapy.
`99223`	Initial hospital care, typically 70 minutes or more	Used by admitting physicians for initial comprehensive assessment and management when starting inpatient IV ceftolozane/tazobactam therapy.

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Summary & Overview

HCPCS C9452: Injection, Ceftolozane 50 mg and Tazobactam 25 mg