Question 1

What is HCPCS code C9465?

Accepted Answer

HCPCS code C9465 is "Injection, durolane". Hyaluronan or derivative, durolane, for intra-articular injection, per dose

Question 2

What category is C9465 in?

Accepted Answer

C9465 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C9465?

Accepted Answer

Use C9465 when billing for injection, durolane. 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 C9465 covered by Medicare?

Accepted Answer

Coverage for C9465 (Injection, durolane) 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 C9465?

Accepted Answer

Documentation for C9465 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).