Summary & Overview
HCPCS G6045: Dihydrocodeinone, Opioid Analgesic
HCPCS Level II code G6045 designates Dihydrocodeinone, an opioid analgesic used in the treatment of moderate to moderately severe pain. As an HCPCS Level II supply/drug code, it identifies the specific medication product for billing and claims adjudication across outpatient settings. Nationally, clear identification of opioid medications through HCPCS codes matters for benefit administration, pharmacy claims processing, controlled substance monitoring, and accurate clinical documentation.
This analysis covers common national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of typical coverage contexts, expected sites of service, and the clinical role of Dihydrocodeinone. The publication summarizes how the code is used on claims, common modifiers encountered, and where additional billing detail is often required.
The report provides benchmarks for claims handling and utilization patterns, highlights relevant policy considerations for outpatient pharmacy and clinic administration, and situates the code within clinical pain-management workflows. Data not provided in the input are noted explicitly where applicable.
Billing Code Overview
HCPCS Level II code G6045 represents Dihydrocodeinone, an opioid analgesic used for moderate to moderately severe pain management. The service type is medication administration/dispensing of a controlled opioid compound. The typical site of service is outpatient pharmacy dispensing or outpatient clinic administration for pain management settings.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult evaluated in an outpatient pain management or primary care clinic for chronic moderate-to-severe nociceptive pain not controlled with non-opioid therapies. The clinician documents a history of persistent pain related to osteoarthritis, post-operative pain, or cancer-related pain, and determines that an opioid analgesic is appropriate. The medication dispensed is G6045 (dihydrocodeinone). The clinical workflow includes medication reconciliation, documentation of indication and prior therapies, informed consent discussion regarding risks and side effects, review of allergies and potential drug interactions, prescribing or dispensing the drug, and scheduling follow-up for efficacy and safety monitoring. Pharmacy dispensing and billing use modifier TC when only the technical component (drug dispensing/administration) is reported by the facility. Typical site of service is outpatient clinic or outpatient pharmacy; inpatient administration or infusion centers may also use the drug when ordered by admitting providers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
TC | Technical component | Use when the facility bills only the technical component of a service (e.g., dispensing or administration) associated with . |