Summary & Overview
HCPCS C9487: Ustekinumab, Intravenous Injection, 1 mg
HCPCS Level II code C9487 denotes ustekinumab supplied for intravenous injection, billed per 1 mg unit. Ustekinumab is a monoclonal antibody used in certain immune-mediated conditions and its IV formulation is significant for hospital outpatient and clinic infusion care. Nationally, precise coding for high-cost biologics like ustekinumab affects claims processing, coverage determinations, and reimbursement flows across public and commercial payers.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for IV ustekinumab, typical sites of service, and what to expect in claims coding for the drug formulation represented by this HCPCS Level II code. The publication summarizes available benchmarks where present, clarifies common billing considerations tied to unit-based drug codes, and highlights relevant policy updates that influence coverage and payment for infused biologics.
This material is intended to inform revenue cycle, clinical billing staff, and policy analysts about the role of C9487 in outpatient infusion billing, how it maps to service delivery, and areas to monitor for payer-specific coverage policies and coding guidance.
Billing Code Overview
HCPCS Level II code C9487 represents ustekinumab, for intravenous injection, 1 mg. This code corresponds to the biologic medication ustekinumab administered via intravenous infusion.
Service Type: Intravenous infusion of a monoclonal antibody
Typical Site of Service: Hospital outpatient infusion center or outpatient clinic infusion suite
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Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with moderate-to-severe Crohn disease presents to the outpatient infusion center for initiation of intravenous ustekinumab therapy. After pre-infusion screening for infections and verification of baseline laboratory results, the patient is weighed and dosed per weight-based IV induction protocol. A registered nurse places an IV catheter, administers pre-medication per clinic protocol if needed, and infuses C9487 (ustekinumab, for intravenous injection, 1 mg) over the recommended infusion time while monitoring vital signs and for infusion reactions. Post-infusion observation occurs for 30–60 minutes, instructions for subcutaneous maintenance dosing are reviewed, and documentation of lot number, NDC, and exact milligrams administered is recorded in the medical record. The same workflow applies for other indications such as plaque psoriasis and psoriatic arthritis when IV induction dosing is required prior to subcutaneous maintenance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a medically necessary E/M is performed on the same day as IV administration and is above and beyond routine pre-infusion assessment |
59 | Distinct procedural service | Use when reporting a separately identifiable service that is not normally reported together with infusion services (e.g., separate procedure on same day)