HCPCS C9257 (Avastin) Fee Schedule

HCPCS C9257 vs. Other Miscellaneous Drugs, Biologicals, and Supplies Codes

The HCPCS C9257 code is part of the Outpatient PPS services used for Miscellaneous Drugs, Biologicals, and Supplies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS C9257 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C9257. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the C9257 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.