Summary & Overview
HCPCS Level II C9467: Rituximab and Hyaluronidase Injection, 10 mg
HCPCS Level II code C9467 denotes an injection of rituximab combined with hyaluronidase, billed per 10 mg unit. This code captures administration of a subcutaneous biologic formulation that allows for faster dispersion and may shorten administration time compared with intravenous formulations. Nationally, accurate coding for such combination biologics is important for consistent reimbursement, inventory tracking, and clinical documentation.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding applicability, common sites of service, and the clinical context for subcutaneous rituximab with hyaluronidase. The publication summarizes typical billing considerations, payer coverage patterns, and relevant benchmarks where available.
This report provides: an explanation of what C9467 represents; expected service settings; the payer landscape covered; and guidance on where to look for policy updates and reimbursement details. Data not provided in the source input—such as specific modifiers, associated taxonomies, ICD-10 pairings, and detailed payer policy language—is noted as unavailable. The focus remains national in scope and centers on coding accuracy and clinical service characterization.
Billing Code Overview
HCPCS Level II code C9467 represents an injection of rituximab and hyaluronidase, measured per 10 mg unit. This code describes a combination biologic formulation intended for subcutaneous administration of rituximab with hyaluronidase to facilitate tissue dispersion.
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Service type: Drug administration (subcutaneous biologic injection)
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Typical site of service: Ambulatory infusion or injection clinic, outpatient clinic, physician office, or other outpatient settings where subcutaneous biologic injections are provided.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a hematologic or autoimmune condition such as non-Hodgkin lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, or certain immune-mediated neurologic disorders who requires systemic B‑cell depletion therapy. The patient is scheduled for subcutaneous administration of C9467 (injection, rituximab and hyaluronidase, 10 mg) in an outpatient infusion or oncology clinic. The workflow includes verification of indication and weight-based dosing, allergy and medication reconciliation, informed consent, baseline vital signs and laboratory review (including CBC and relevant chemistries), premedication as indicated (acetaminophen, antihistamine, and/or corticosteroid), preparation of the subcutaneous product by pharmacy per aseptic technique, administration by a registered nurse with a recommended observation period for infusion-related reactions, documentation of lot number and expiration, billing using C9467 per 10 mg unit, and coordination for follow-up assessment of therapeutic response and adverse events. Typical sites of service are hospital outpatient departments, ambulatory infusion centers, and oncology or rheumatology clinics that provide parenteral biologic therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service |