Summary & Overview
HCPCS C9475: Injection, necitumumab, 1 mg
HCPCS Level II code C9475 denotes the injectable oncology biologic necitumumab measured per 1 mg. As a drug-specific HCPCS code, C9475 is used on outpatient and physician-administered service lines to capture the units of necitumumab provided to patients receiving parenteral cancer therapy. Nationally, accurate reporting of drug HCPCS codes like C9475 matters for clinical documentation, payer adjudication, and aggregated drug utilization and spend reporting for oncology agents.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and typical site of service, comparisons of payer coverage patterns where available, benchmark and utilization context when reported by payers, and any notable policy or billing guidance relevant to HCPCS drug coding. The publication highlights coding conventions, unit reporting considerations for per-milligram drug HCPCS codes, and implications for service-line billing in infusion centers and hospital outpatient departments.
Data not available in the input is noted where payer-specific policies, modifiers, taxonomy, ICD-10 pairings, and related codes would normally be detailed.
Billing Code Overview
HCPCS Level II code C9475 represents Injection, necitumumab, 1 mg. This code is used to report administration or supply of the monoclonal antibody necitumumab in 1 mg units. Service type: drug administration/single-dose injectable biologic. Typical site of service: infusion center or hospital outpatient department for parenteral oncology therapy.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced or metastatic squamous non-small cell lung cancer receiving systemic targeted therapy. The oncology clinic schedules an infusion visit for administration of C9475 (Injection, necitumumab, 1 mg). The workflow begins with an oncology evaluation confirming indication and recent laboratory results (CBC, CMP) and verifies vascular access (peripheral IV or implanted port). The patient is triaged by a nurse who reviews allergies, vital signs, and prior infusion reactions. Pharmacy prepares a weight- or BSA‑based dose by compounding the required milligram amount of necitumumab and labels it per facility policy. During the visit, an infusion nurse places IV access, performs a baseline assessment, and initiates the monoclonal antibody infusion per the provider’s order and institutional protocol, with appropriate premedication if indicated. The nurse documents infusion start and stop times, medication lot numbers, and any adverse reactions. Following infusion, the patient is monitored for infusion-related reactions for a designated observation period and discharged with follow-up oncology appointments and instructions. Billing records list drug units by C9475 per milligram administered, and the visit may include separate billing for infusion administration and monitoring services as applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 |