C9257 HCPCS code: Injection, bevacizumab, 0.25 mg
C9257 is the HCPCS Level II code for injection, bevacizumab, 0.25 mg. In 2024 Medicare paid an average of $1.39 per service for C9257 across 4,190 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 10 per day on outpatient hospital claims. Medicare volume rose 6% from 2022 to 2024 (3,950 to 4,190 services). In 2024, about 31 clinicians billed Medicare for C9257 for 306 beneficiaries; Michigan, New Jersey, Pennsylvania accounted for 64% 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 | 2010-01-01 |
| Last action effective | 2010-01-01 |
Who bills C9257 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 31 |
| Medicare beneficiaries | 306 |
| States with claims | 9 |
| Share of services in top 3 states (Michigan, New Jersey, Pennsylvania) | 64% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for C9257, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,950 | 309 | $1.71 | $1.30 |
| 2023 | 3,464 | 301 | $1.78 | $1.38 |
| 2024 | 4,190 | 306 | $1.80 | $1.39 |
States with the most C9257 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Michigan | 976 | $1.37 |
| New Jersey | 905 | $1.42 |
| Pennsylvania | 791 | $1.38 |
| California | 532 | $1.37 |
| North Carolina | 330 | $1.43 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 10 | Anatomic Consideration |
| practitioner claims | 10 | Anatomic Consideration |
Medicare policy articles for this code
- A52370: Billing and Coding: Bevacizumab and biosimilars (National Government Services, Inc. (MAC - Part A, MAC - Part B))
- A53008: Billing and Coding: Intraocular Bevacizumab (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
Covered diagnoses (568 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 2 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 2 |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye | 2 |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral | 2 |
| E08.3311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye | 2 |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye | 2 |
| E08.3313 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | 2 |
| E08.3411 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye | 2 |
| E08.3412 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye | 2 |
| E08.3413 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral | 2 |
Showing 10 of 568. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for C9257
- 2010-01-01: C9257 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 C9257?
C9257 is the HCPCS Level II code for injection, bevacizumab, 0.25 mg. Short descriptor: "Bevacizumab injection".
How much does Medicare pay for C9257?
In 2024, the average Medicare payment was $1.39 per service (average allowed $1.80).
Does Medicare cover C9257?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for C9257?
Medicare policy articles that cite C9257 list 568 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include E08.311 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema), E08.3211 (Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye), E08.3212 (Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of C9257 can be billed per day?
10 on outpatient hospital claims; 10 on practitioner claims (NCCI medically unlikely edits).
Related C92 codes
- C9248 — Injection, clevidipine butyrate, 1 mg
- C9250 — Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml
- C9254 — Injection, lacosamide, 1 mg
- C9275 — Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose
- C9285 — Lidocaine 70 mg/tetracaine 70 mg, per patch
- 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 C9257
- Watch C9257 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C9257
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.