C9486 Granisetron ER Injection Reimbursement

HCPCS Level II code C9486 denotes a 0.1 mg injection of granisetron extended release, an antiemetic formulation deployed primarily to prevent chemotherapy‑induced nausea and vomiting. Nationally, accurate coding for extended‑release antiemetics matters for care coordination in oncology, outpatient infusion billing, and monitoring utilization of long‑acting supportive therapies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical sites of service, and the clinical context for use in oncology and other settings where prolonged antiemetic control is indicated.

This publication summarizes benchmarking and coverage contexts relevant to C9486, highlights where stakeholders should expect to see this code on outpatient infusion service lines, and outlines the clinical rationale for an extended‑release granisetron formulation compared with short‑acting alternatives. It also notes areas where payer policy updates and claims processing considerations commonly arise. Data not available in the input will be explicitly noted where applicable.

Billing Code Overview

HCPCS Level II code C9486 represents Injection, granisetron extended release, 0.1 mg. This code describes a single administration of an extended‑release formulation of granisetron, an antiemetic used to prevent nausea and vomiting associated with chemotherapy and other emetogenic therapies.

Service Type: Injection

Typical Site of Service: Outpatient infusion center or clinic, oncology clinic, or other outpatient medical setting

Data not available in the input.

Clinical Context

A 62-year-old female with a history of metastatic breast cancer is scheduled to receive a single-dose intravenous antiemetic during a chemotherapy visit to prevent acute and delayed chemotherapy-induced nausea and vomiting (CINV). The clinic uses an extended-release formulation of granisetron administered by subcutaneous or intramuscular injection when IV access is limited or when prolonged antiemetic coverage is desired. The patient arrives to the oncology infusion center, vital signs are recorded, and the medication administration record is reviewed for allergies and prior antiemetic response. The nurse verifies the order for C9486 (Injection, granisetron extended release, 0.1 mg), prepares the appropriate syringe, and administers the injection per protocol. Observation for immediate hypersensitivity occurs for 15–30 minutes, and documentation includes medication lot number, dose, route, site, and patient tolerance. Subsequent visits document efficacy and any delayed adverse effects; billing is submitted using the HCPCS Level II code C9486 along with the chemotherapy administration codes and the primary oncology diagnosis.

Coding Specifications

Modifier	Description	When to Use
`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Use if an unrelated E/M is performed the same day as administration during a postoperative global period

Taxonomy Code	Specialty	Notes
`207RC0000X`	Medical Oncology	Primary specialty ordering and overseeing CINV prophylaxis
`208100000X`	Hematology/Oncology	Specialists managing chemotherapy regimens and supportive care
`363A00000X`	Registered Nurse	Common clinician administering extended-release injections in infusion centers
`207K00000X`	Internal Medicine	Hospitalists or internists involved in inpatient administration
`364S00000X`	Advanced Practice Nurse Practitioner	APNs who may order and administer supportive oncology medications

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.11`	Encounter for antineoplastic chemotherapy	Common primary encounter code used during administration of chemotherapy and associated supportive medications such as extended-release granisetron
`Z51.0`	Encounter for antineoplastic radiation therapy	Use when antiemetic prophylaxis is provided in the context of radiation therapy that can cause nausea
`R11.0`	Nausea	Symptom code when patients present with nausea requiring antiemetic therapy
`R11.2`	Nausea with vomiting, unspecified	Used when patients exhibit nausea and vomiting related to chemotherapy and need prophylaxis or treatment
`C50.919`	Malignant neoplasm of unspecified site of right female breast	Example of a common cancer diagnosis where chemotherapy and CINV prophylaxis with granisetron are used

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used when antiemetic is administered as part of an IV infusion visit for chemotherapy support
`96366`	Intravenous infusion, each additional hour (List separately in addition to code for primary service)	Used when prolonged infusion services are billed alongside supportive medication administration
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	May be used for billing injection administration when oral/IV routes are not used and facility requires a CPT for injection administration
`96413`	Chemotherapy administration, intravenous infusion technique; each additional sequential infusion/drug (up to 1 hour)	Relevant when granisetron is administered during a multi-drug chemotherapy infusion session
`99212`	Office or other outpatient visit for the evaluation and management of an established patient, typically 10 minutes	Used when a separate, billable E/M occurs the same day as the injection and meets documentation requirements

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Summary & Overview

HCPCS C9486: Granisetron Extended-Release Injection, 0.1 mg