Question 1

What is HCPCS code C9454?

Accepted Answer

HCPCS code C9454 is "Inj, pasireotide long acting". Injection, pasireotide long acting, 1 mg

Question 2

What category is C9454 in?

Accepted Answer

C9454 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C9454?

Accepted Answer

Use C9454 when billing for inj, pasireotide long acting. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is C9454 covered by Medicare?

Accepted Answer

Coverage for C9454 (Inj, pasireotide long acting) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for C9454?

Accepted Answer

Documentation for C9454 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).