Summary & Overview

HCPCS C9454: Pasireotide Long-Acting Injection, 1 mg

HCPCS Level II code C9454 designates a long-acting injectable formulation of pasireotide at a unit dose of 1 mg. This code is used to bill for administration or provision of the long-acting somatostatin analog in outpatient and ambulatory settings where specialty injectable therapies are delivered. Nationally, the code is relevant for specialty pharmaceutical billing, utilization tracking, and payer coverage determinations related to rare endocrine or oncologic conditions for which pasireotide is indicated.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, the typical sites of service, and the clinical context of pasireotide as a long-acting injectable therapy. The publication summarizes benchmarking considerations, common billing and coding contexts, and any recent policy or coverage updates where available. It also highlights related billing issues such as unitization, site-specific administration considerations, and where to look for payer-specific coverage rules.

Data not available in the input will be noted explicitly in specific sections. The content is intended for national audiences involved in revenue cycle, specialty pharmacy, and clinical billing operations seeking a clear reference for HCPCS Level II code C9454.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9454HCPCS Level IIpasireotidelong-acting injectionspecialty pharmacyoutpatient infusiondrug billinginjectable therapy

Billing Code Overview

HCPCS Level II code C9454 describes Injection, pasireotide long acting, 1 mg. This billing code represents a prescription injectable formulation of pasireotide intended for long-acting release, with the unit defined as 1 mg per billing increment.

Service type: Injectable long-acting somatostatin analog therapy
Typical site of service: Outpatient infusion clinic, physician office, or other ambulatory care settings where long-acting injectable medications are administered

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 55-year-old patient with a diagnosis of Cushing disease or acromegaly receives a specialist-administered, long-acting somatostatin analogue injection of pasireotide. The medication C9454 (Injection, pasireotide long acting, 1 mg) is used in an outpatient infusion clinic, specialty clinic, or ambulatory surgical center where an endocrinologist or advanced practice provider prepares and documents the dose. The clinical workflow includes medication verification and consent, vital signs and brief assessment for contraindications or hypersensitivity, preparation of the long-acting injectable formulation by a licensed clinician or pharmacist, administration via deep intramuscular injection (typically gluteal), post-injection observation for adverse reactions (usually 15–30 minutes), and documentation of lot number, dose, site, and patient tolerance in the medical record. Claims submission includes the C9454 HCPCS Level II code for the drug; appropriate ICD-10 diagnosis codes for the underlying endocrine disorder; and, when applicable, facility or professional service CPT codes for the visit, injection administration, or observation services performed at the same encounter.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service on the same day	Use when a distinct E/M visit is performed and documented in addition to administration of `C9454`.
`59`	Distinct procedural service	Use to indicate a distinct service or procedure that is separate from other services billed the same day.
`76`	Repeat procedure or service by same physician	Use when the injection or related procedure is repeated later the same day by the same provider.
`77`	Repeat procedure by another physician	Use when another clinician repeats the injection or related procedure the same day.
`JW`	Drug amount discarded/not administered	Use if a portion of the reconstituted pasireotide is discarded and must be reported per payer policy.
`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Use if the E/M is unrelated to a surgical postoperative period when `C9454` is administered.
`GA`	Waiver of liability statement on file (advanced beneficiary notice)	Use when a signed ABN/waiver exists and the service may be denied by Medicare.
`KX`	Requirements specified in the medical policy have been met	Use when payer-specific medical necessity criteria for pasireotide have been documented.
`XE`	Separate encounter, a distinct service	Use when the encounter is distinct from other services on the same day.
`XP`	Separate practitioner	Use to indicate services performed by a different practitioner that are distinct from those of the billing practitioner.

Taxonomy Code	Specialty	Notes
`207RE0101X`	Endocrinology, Diabetes & Metabolism	Endocrinologists commonly manage indications for pasireotide and supervise therapy.
`363L00000X`	Clinical Pharmacology	Clinical pharmacists in specialty clinics may prepare and verify long‑acting formulations.
`363A00000X`	Nurse Practitioner	Advanced practice providers frequently perform injections and follow-up assessments.
`163WL0500X`	Physician Assistant	PAs in endocrinology or infusion clinics often administer and document long‑acting injections.
`261QM0800X`	Hematology/Oncology (supportive care)	Oncology supportive care clinics may administer specialty endocrine agents when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E24.0`	Pituitary-dependent Cushing disease	Pasireotide is indicated for patients with Cushing disease when surgery is not an option or has failed; directly targets ACTH-secreting pituitary adenomas.
`E22.0`	Acromegaly and gigantism	Pasireotide may be used for acromegaly patients with inadequate response to other therapies or when surgery is not curative.
`E24.9`	Cushing syndrome, unspecified	Used when documentation supports hypercortisolism but the exact etiology is not yet specified; supports use of medical therapy like pasireotide.
`E24.8`	Other Cushing syndrome	Captures less common or specified forms of Cushing syndrome that may warrant medical therapy with pasireotide.
`R63.5`	Abnormal weight gain	Relevant as a symptom associated with Cushing syndrome and acromegaly management and monitoring during therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular)	Commonly used to bill the administration service when a medication like `C9454` is given as an intramuscular injection by a clinician.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Typical E/M code for evaluation, documentation of indication, and counseling on pasireotide during the same visit when medically necessary.
`99070`	Supplies and materials (except devices) provided by the physician over and above those usually included with the office visit or services	Used to bill for additional disposable supplies required for medication preparation and administration beyond usual supplies.
`96401`	Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic (single or initial substance/drug)	May be used in some oncology practice settings when coding administration of specialty injectable medications if payer policy aligns with medication classification.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Performed before or after administration when cardiac monitoring is indicated due to potential pasireotide effects on glucose or QT interval in high-risk patients.