Summary & Overview
HCPCS C9472: Injection of Talimogene Laherparepvec, 1M pfu
HCPCS Level II code C9472 denotes the injection of talimogene laherparepvec at a unit of 1 million plaque forming units (pfu). As an intralesional oncolytic viral therapy, talimogene laherparepvec plays a distinct role in cancer treatment, especially for accessible cutaneous, subcutaneous, and nodal lesions. Nationally, appropriate coding for this medication is important for accurate utilization tracking, claims processing, and access to therapy.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find information on payer coverage patterns and benchmarks, clinical context for use of talimogene laherparepvec, and relevant billing considerations tied to service setting and unitization. The publication summarizes typical sites of service and clarifies the service type captured by the code.
This report provides clinicians, billing professionals, and policy stakeholders with an overview of coding intent, expected clinical applications, and the billing construct for C9472. Data limitations are noted where input did not supply payer-specific modifiers, associated taxonomies, ICD-10 diagnoses, or related codes. The content focuses on national relevance for coding, reimbursement navigation, and administrative clarity rather than state-level policy detail.
Billing Code Overview
HCPCS Level II code C9472 represents injection of talimogene laherparepvec, measured per 1 million plaque forming units (pfu). This code is used to bill for administration of the oncolytic viral therapy talimogene laherparepvec, which is delivered by injection directly into tumor lesions.
-
Service type: Intralesional oncolytic viral therapy administration
-
Typical site of service: Ambulatory cancer clinic, outpatient infusion center, or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with unresectable, recurrent, or regionally advanced melanoma receives intralesional oncolytic immunotherapy using talimogene laherparepvec. The treatment is administered in an outpatient clinic or ambulatory infusion center by a dermatologist, surgical oncologist, or medical oncologist trained in lesion injection. Prior to injection, the lesion(s) are evaluated for suitability (accessible cutaneous, subcutaneous, or nodal lesions), lesion measurements and photographs are obtained, and informed consent is confirmed. Local antiseptic preparation and, if needed, local anesthesia are applied. The provider uses ultrasound guidance for deep or nonpalpable nodal lesions. The vial is reconstituted per manufacturer guidance and doses are calculated in plaque-forming units; billing is reported per C9472 for each 1 million pfu increment. Post-injection observation for immediate adverse events (bleeding, infection, pain, systemic reactogenicity) is performed in clinic for a short period. Treatment cycles occur every 2–4 weeks, with response assessment by physical exam and imaging per oncology follow-up protocols.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Use when talimogene laherparepvec injection is a separate and distinct service from another procedure performed at the same visit and not ordinarily reported together. |