Summary & Overview
HCPCS C9494: Injection, Ocrelizumab, 1 mg
HCPCS Level II code C9494 designates ocrelizumab dosed by the milligram (injection, ocrelizumab, 1 mg). The code is used to report the administered quantity of this monoclonal antibody, which is important for billing, inventory management, and policy coverage determinations for infusion-delivered biologic therapies nationwide. Ocrelizumab is commonly used in neurology and immunology indications and is typically administered in infusion settings.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the likely service settings, and the clinical context for ocrelizumab administration. The publication also outlines typical benchmarking and coverage topics readers can expect, including reimbursement unitization, site-of-service considerations, and payer coverage variability. Where specific payer or claim-level data are not provided in the input, the text notes that those items are not available.
This summary is intended for coding professionals, billing managers, and policy analysts seeking a national-level reference for using HCPCS Level II code C9494 in administrative and clinical workflows.
Billing Code Overview
HCPCS Level II code C9494 represents injection, ocrelizumab, 1 mg. This code describes the drug administration unit for ocrelizumab measured per milligram.
Service type: injectable biologic therapy
Typical site of service: infusion center, outpatient hospital infusion clinic, or physician office infusion suite
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 42-year-old female with relapsing-remitting multiple sclerosis presents to the outpatient infusion clinic for her scheduled disease-modifying therapy. The patient has an established diagnosis of multiple sclerosis and has previously received baseline screening (CBC, hepatitis B serologies, IgG, tuberculosis screening) and required vaccinations prior to initiation. The infusion order is for C9494 (injection, ocrelizumab, 1 mg) to be administered intravenously as part of a weight-based or fixed dosing regimen per product labeling. The clinical workflow includes verification of identity and allergies, pre-infusion vitals and assessment, optional premedication (e.g., methylprednisolone, antihistamine, antipyretic) per protocol, preparation of the calculated drug volume by pharmacy, IV access placement, infusion administration with monitoring for infusion-related reactions, post-infusion observation for a period determined by facility protocol, documentation of lot number and amount administered, and scheduling of the next dose. Typical sites of service are outpatient hospital infusion center, physician office-based infusion suite, or ambulatory infusion center. The typical patient scenario involves chronic disease management with periodic infusions (initial dosing followed by maintenance dosing at manufacturer-recommended intervals) and coordinated neurology follow-up for efficacy and safety monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure |