Summary & Overview
HCPCS C9492: Durvalumab Injection, 10 mg
HCPCS Level II code C9492 represents a 10 mg unit of durvalumab administered by injection, used in oncology and immunotherapy treatments. As a drug-specific HCPCS Level II code, it is used on outpatient and infusion service lines to report the supply or administration of this antineoplastic biologic. Nationally, accurate reporting of HCPCS Level II drug codes like C9492 is important for consistent claims processing, reimbursement transparency, and drug utilization monitoring across payers.
Key payers included in the coverage review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is used in billing and service settings, common modifiers associated with HCPCS drug billing, and contextual clinical information about durvalumab’s role as an immunotherapy agent. The publication also summarizes typical sites of service and service line implications for outpatient infusion centers.
This guide helps billing managers, revenue cycle staff, and policy analysts understand the billing context for C9492, what to expect on adjudication pathways with major national payers, and where to look for policy or coverage updates affecting oncology drug billing.
Billing Code Overview
HCPCS Level II code C9492 denotes injection, durvalumab, 10 mg. This code represents a parenteral administration of the immunotherapy agent durvalumab in 10 mg increments.
Service type: Drug administration / Injectable oncology therapy
Typical site of service: Outpatient infusion center or clinic
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with unresectable Stage III non-small cell lung cancer (NSCLC) who has completed concurrent chemoradiation and is receiving consolidation immunotherapy with durvalumab. The patient presents to an outpatient oncology infusion center for scheduled intravenous administration of durvalumab at a dose proportional to body weight (billed as C9492 per 10 mg).
The clinical workflow: the patient checks in and nursing obtains vital signs, reviews recent labs (including comprehensive metabolic panel and complete blood count), and confirms no acute infusion contraindications. An oncology clinician verifies the treatment order and consent, documents indication and treatment cycle, and reviews prior adverse events. An IV access is established (peripheral or port), premedications are given if indicated, and the durvalumab infusion is prepared by pharmacy. During infusion, nursing monitors for infusion-related reactions and documents start/stop times and patient tolerance. After completion, the patient is observed for a brief period and discharged with follow-up oncology appointments and documentation of the administered durvalumab dose and lot number.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple Procedures | Used when multiple distinct procedures or services are performed on the same day and the payer requires identification of additional procedures (often appends to secondary codes). |