C9046 HCPCS code: Cocaine hydrochloride nasal solution (goprelto), 1 mg
C9046 is the HCPCS Level II code for cocaine hydrochloride nasal solution (goprelto), 1 mg. In 2022 Medicare paid an average of $0.97 per service for C9046 across 36,489 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 160 per day on outpatient hospital claims. In 2022, about 36 clinicians billed Medicare for C9046 for 268 beneficiaries; Maryland, Kansas, California accounted for 63% of services.
Code details
| Field | Value |
|---|---|
| Section | C codes — Outpatient PPS (hospital outpatient temporary codes) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 53 |
| BETOS category | O1E — Other drugs |
| Added | 2019-04-01 |
| Last action effective | 2023-01-01 |
Who bills C9046 (2022)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 36 |
| Medicare beneficiaries | 268 |
| States with claims | 9 |
| Share of services in top 3 states (Maryland, Kansas, California) | 63% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for C9046, 2022–2022
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 36,489 | 268 | $1.22 | $0.97 |
States with the most C9046 services (2022)
| State | Services | Avg. paid |
|---|---|---|
| Maryland | 9,280 | $0.97 |
| Kansas | 6,880 | $0.96 |
| California | 5,126 | $0.97 |
| Tennessee | 4,976 | $0.98 |
| Texas | 3,200 | $0.97 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 160 | Prescribing Information |
| practitioner claims | 160 | Prescribing Information |
What changed for C9046
- 2019-04-01: C9046 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code C9046?
C9046 is the HCPCS Level II code for cocaine hydrochloride nasal solution (goprelto), 1 mg. Short descriptor: "Cocaine hcl nasal (goprelto)".
How much does Medicare pay for C9046?
In 2022, the average Medicare payment was $0.97 per service (average allowed $1.22).
Does Medicare cover C9046?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of C9046 can be billed per day?
160 on outpatient hospital claims; 160 on practitioner claims (NCCI medically unlikely edits).
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Next steps
- Run a reimbursement report for a device billed under C9046
- Watch C9046 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C9046
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.