Summary & Overview
HCPCS C9465: Durolane Intra-Articular Injection, Per Dose
HCPCS Level II code C9465 denotes a single dose of hyaluronan derivative branded as Durolane for intra-articular injection. This code is used to report viscosupplementation administered directly into a joint space, a procedure frequently performed for symptomatic management of degenerative joint conditions. Nationally, proper use of C9465 matters for accurate outpatient billing, inventory tracking of high-cost injectable products, and alignment with payer coverage policies.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise discussion of clinical context for intra-articular hyaluronan injections, common sites of service, and the implications for billing workflows. The publication outlines typical benchmarks and coverage considerations, highlights recent policy developments affecting reimbursement and prior authorization practices, and summarizes coding nuances that affect claims processing and revenue cycle operations.
This summary serves clinicians, billing professionals, and policy analysts seeking a national overview of HCPCS Level II code C9465, its clinical application, and the payer landscape relevant to intra-articular viscosupplementation.
Billing Code Overview
HCPCS Level II code C9465 represents hyaluronan or derivative, durolane, for intra-articular injection, per dose. The service type is an intra-articular viscosupplementation injection intended to provide joint lubrication and symptomatic relief. The typical site of service is an outpatient clinical setting such as an orthopedic clinic, rheumatology clinic, or ambulatory surgery center, where intra-articular injections are performed.
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with symptomatic osteoarthritis of the knee presents to an orthopedic clinic with persistent joint pain, stiffness, and limited function despite conservative measures (physical therapy, NSAIDs, and activity modification). After clinical evaluation and review of imaging that confirms degenerative changes without inflammatory arthritis or infection, the orthopedic provider recommends an intra-articular viscosupplementation injection using C9465 (Hyaluronan or derivative, Durolane). The procedure is performed in an outpatient clinic procedure room. After informed consent, the patient is positioned supine with the knee prepped and draped in a sterile fashion. Local anesthetic may be applied to the skin. Using landmark- or image-guided technique, the provider inserts a needle into the joint space and administers one dose of C9465. Post-procedure monitoring occurs for a short period to assess immediate adverse reactions, and the patient receives post-injection instructions including activity modification and signs of infection to watch for. Follow-up is scheduled to assess pain relief and function, and to determine need for additional injections or alternative therapies.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service on the same day |