Summary & Overview
HCPCS C9474: Injection, irinotecan liposome, 1 mg
HCPCS Level II code C9474 designates a unit of 1 mg for injection of irinotecan liposome, a liposomal formulation used in chemotherapy infusions. This code is relevant nationally for billing oncology drug administrations in hospital outpatient departments, ambulatory infusion centers, and oncology clinics where liposomal irinotecan is administered.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of code definition and clinical context, typical sites of service, payer coverage considerations, and where to locate related billing and reimbursement resources. The publication outlines common benchmarks and policy updates affecting HCPCS drug coding and payment methodology for infused oncology agents, and provides clinical context on how this code maps to chemotherapy infusion workflows.
This summary supports providers, coders, and billing managers seeking concise information on HCPCS Level II code C9474, including what the code represents, which payers commonly cover such services, and the types of information to consult for reimbursement and coding compliance. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code C9474 represents Injection, irinotecan liposome, 1 mg. This entry denotes a billed drug administration unit for a liposomal formulation of irinotecan, an anti-cancer chemotherapeutic agent formulated for intravenous use.
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Service type: Chemotherapy drug administration (intravenous oncology infusion)
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Typical site of service: Hospital outpatient department, ambulatory infusion center, or oncology clinic
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced solid tumor disease who has progressed on first-line therapies and is a candidate for targeted nanoparticle-delivered chemotherapy. The patient presents to an outpatient infusion center or hospital outpatient department for administration of C9474 (injection, irinotecan liposome, 1 mg). Prior to infusion, the oncology team confirms diagnosis, reviews prior therapies, obtains baseline labs (CBC with differential, comprehensive metabolic panel, liver function tests), and assesses performance status. Vascular access is established via peripheral IV or implanted port. The pharmacy compounds the dose based on body surface area and schedule. During infusion, nursing monitors vital signs, infusion tolerance, and for early signs of adverse reactions such as infusion‑related symptoms, diarrhea, or neutropenia. Post‑infusion, the patient is observed per institutional protocol, given antiemetic or antidiarrheal medications as needed, and scheduled for follow‑up lab monitoring and subsequent treatment cycles in the outpatient infusion suite or hospital outpatient department depending on the patient’s clinical status and payer requirements. Typical sites of service are outpatient infusion centers and hospital outpatient departments. Common patient scenarios include metastatic colorectal cancer or other indications for liposomal irinotecan after prior therapy failure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |