Summary & Overview
HCPCS C9476: Injection, daratumumab, 10 mg
HCPCS Level II code C9476 designates a 10 mg unit of daratumumab administered by injection, a monoclonal antibody used primarily in oncology practice. As a drug-specific HCPCS Level II entry, C9476 enables itemized billing for daratumumab doses across outpatient infusion settings, supporting billing clarity and claims adjudication for high-cost biologic therapy.
Key payers included in the national context are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Coverage and reimbursement practices for daratumumab often affect site-of-care decisions, prior authorization workflows, and pharmacy versus medical benefit routing.
Readers will find a concise overview of the code's clinical and billing role, payer coverage scope, and the typical service settings where the code is applied. The publication summarizes benchmark considerations for utilization of unit-based HCPCS drug codes, common billing challenges for injectable oncology agents, and policy updates relevant to HCPCS drug reporting and outpatient administration. Data not provided in the input are noted where applicable. The content is intended for national audiences including coding professionals, revenue cycle leaders, and clinicians involved in oncology drug administration and billing.
Billing Code Overview
HCPCS Level II code C9476 denotes Injection, daratumumab, 10 mg. This code represents a billed unit of the monoclonal antibody daratumumab delivered by injection, with each unit reflecting 10 mg of the drug.
Service Type: Therapeutic drug administration (intravenous or subcutaneous injection)
Typical Site of Service: Infusion center, outpatient oncology clinic, or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with multiple myeloma or other plasma cell dyscrasia presenting for intravenous or subcutaneous immunotherapy with daratumumab. The patient has been referred to an oncology infusion center after hematology/oncology evaluation confirmed an indication for anti-CD38 monoclonal antibody therapy. Prior to the visit, medication reconciliation, allergy review, baseline vital signs, and premedication orders (eg, corticosteroid, antihistamine, antipyretic) are completed by nursing. On the day of service the nurse verifies consent, establishes intravenous access or confirms the subcutaneous route, administers required premedications, prepares the daratumumab dose per weight and vial concentration, and documents lot numbers. The medication C9476 represents daratumumab billed per 10 mg increment; pharmacy and billing staff convert the dispensed milligrams to the number of units billed. During infusion or injection the infusion nurse monitors for infusion-related reactions, documents vital signs and any adverse events, and provides post‑administration observation per protocol. Follow-up includes scheduled oncology visits, laboratory monitoring (including CBC, CMP, and disease markers), and documentation of subsequent doses and response assessment in the patient chart.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When a separately identifiable service or procedure is performed on the same day that is not normally reported together with the primary service |