C9490 bezlotoxumab HCPCS Reimbursement

HCPCS Level II code C9490 denotes the administration of bezlotoxumab 10 mg by injection, a monoclonal antibody used to reduce recurrence of Clostridioides difficile infection. Nationally, use of this HCPCS Level II code matters because it captures biologic therapy delivered in outpatient infusion settings and informs payer coverage, utilization tracking, and cost management for an adjunctive therapy to standard antibiotic regimens.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose and typical sites of service, comparison of payer coverage approaches and reimbursement considerations, common billing and documentation themes, and the policy context that influences access to bezlotoxumab. The summary highlights benchmarks for utilization and spend where available and notes areas where data are not provided in the input.

This publication is intended for clinical billing managers, pharmacy and therapeutics committees, and policy analysts seeking a national-level briefing on how HCPCS Level II code C9490 is used and reimbursed across major payers.

Billing Code Overview

HCPCS Level II code C9490 represents an injection of bezlotoxumab, 10 mg. This billing code captures administration of the monoclonal antibody indicated for prevention of recurrence of Clostridioides difficile infection in appropriate clinical contexts.

Service type: Injectable biologic medication administration
Typical site of service: Infusion center, hospital outpatient department, or other outpatient infusion setting

Clinical Context

A typical patient is an adult hospitalized or recently discharged who has recurrent Clostridioides difficile infection (rCDI) or is at high risk for recurrence following completion of antibiotic therapy for C. difficile. The patient completes appropriate anti-C. difficile antibiotic treatment (for example, vancomycin or fidaxomicin) and is considered for adjunctive monoclonal antibody therapy to reduce recurrence risk. The infusion clinic or hospital infusion service schedules a single intravenous dose of bezlotoxumab dosed per product labeling (single 10 mg vial units are billed as C9490 per 10 mg). The clinical workflow includes verification of indication and weight-based dosing if relevant to product preparation, informed consent, IV access placement, baseline vital signs and allergy review, preparation of the infusion by pharmacy, administration over the recommended infusion time with monitoring for infusion reactions, documentation of lot number and vial count, and post-infusion observation for adverse events prior to discharge or return to the inpatient unit.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	When another unrelated service was performed on the same day and needs to be reported separately from the drug administration if a modifier is required by payer policy

Taxonomy Code	Specialty	Notes
`207Q00000X`	Infectious Disease Specialist	Common clinician to consult and manage rCDI and to recommend bezlotoxumab
`208000000X`	Gastroenterology	Often involved in management of recurrent C. difficile colitis and treatment planning
`363L00000X`	Hematology/Oncology (Infusion)	Infusion nurses and centers that administer biologic IV agents; taxonomy used for infusion clinic providers
`338M00000X`	Hospitalists	Hospital-based providers who may order and oversee administration during inpatient stays
`367500000X`	Pharmacy Services (Clinical Pharmacist)	Clinical pharmacists involved in dosing, preparation, and stewardship of monoclonal antibody therapies

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A04.7`	Enterocolitis due to Clostridioides difficile	Primary diagnosis for C. difficile infection where bezlotoxumab is indicated to reduce recurrence risk
`A04.71`	Enterocolitis due to Clostridioides difficile, recurrent	Directly denotes recurrent infection; key indication for adjunctive bezlotoxumab use
`A04.72`	Enterocolitis due to Clostridioides difficile, carrier	May appear in documentation when patient is a carrier; clinical relevance is limited for therapy
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Occasionally used as secondary diagnosis when colitis features are documented but CDI is confirmed
`Z79.2`	Long term (current) use of antibiotics	Relevant as antecedent therapy that increases recurrence risk and supports consideration of bezlotoxumab

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Common code used to report the initial infusion administration time for bezlotoxumab when infusion duration fits the billing interval
`96366`	Intravenous infusion, each additional hour (list separately in addition to code for primary infusion)	Used if bezlotoxumab infusion extends beyond the first hour and payer allows hourly reporting
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Sometimes used by infusion centers for monoclonal antibody administrations when facility/payer protocols specify oncology administration codes
`96415`	Chemotherapy administration, each additional hour	Used when administration time exceeds the initial hour under chemotherapy administration coding conventions
`36415`	Collection of venous blood by venipuncture	Performed if baseline labs or therapeutic drug monitoring are drawn before or after infusion
`99152`	Moderate sedation services provided by the same physician performing the procedure (if applicable)	Included only if moderate sedation is required for infusion-related procedures (rare for bezlotoxumab)

OpenPayer

Summary & Overview

HCPCS Level II C9490: Injection, bezlotoxumab, 10 mg