C9254 HCPCS code: Injection, lacosamide, 1 mg
C9254 is the HCPCS Level II code for injection, lacosamide, 1 mg. 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 400 per day on outpatient hospital claims.
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 | 2010-01-01 |
| Last action effective | 2010-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 400 | Prescribing Information |
| practitioner claims | 400 | Clinical: CMS Workgroup |
What changed for C9254
- 2010-01-01: C9254 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 C9254?
C9254 is the HCPCS Level II code for injection, lacosamide, 1 mg. Short descriptor: "Injection, lacosamide".
Does Medicare cover C9254?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of C9254 can be billed per day?
400 on outpatient hospital claims; 400 on practitioner claims (NCCI medically unlikely edits).
Related C92 codes
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- C9257 — Injection, bevacizumab, 0.25 mg
- C9275 — Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose
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- C9290 — Injection, bupivacaine liposome, 1 mg
- C9293 — Injection, glucarpidase, 10 units
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Next steps
- Run a reimbursement report for a device billed under C9254
- Watch C9254 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C9254
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.