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HCPCS C9257 · Level II · Part B drug

C9257: bevacizumab (Avastin), HCPCS Level II drug code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: OPPS Addendum B: October 2026 (effective October 1, 2026); OPPS NDC-HCPCS crosswalk: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); ASC Addendum BB (covered ancillary services): October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for C9257

Billing unit
0.25 MG
Bevacizumab injection
OPPS payment rate
$1.887
no ASP limit; SI K, October 2026
Practitioner MUE
10
MAI 2
OPPS status
SI K
APC 1281
NCCI exposure
no PTP pairs
Coverage articles
2
11 states

TL;DR

HCPCS C9257 is the Level II code for Injection, bevacizumab, 0.25 mg, billed per 0.25 MG. CMS publishes no ASP payment limit for it; hospital outpatient departments are paid separately under OPPS (status indicator K, $1.887 per billing unit in October 2026). The practitioner MUE allows up to 10 units per date of service (MAI 2). C9257 is billed in units of 0.25 MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. Other HCPCS codes whose descriptor names bevacizumab: Q5160 (biosimilar bevacizumab-nwgd (Jobevne) from Biocon Biologics Inc.; billed per 10 mg); Q5129 (biosimilar bevacizumab-adcd (Vegzelma) from Celltrion USA, Inc.; billed per 10 mg); Q5126 (biosimilar bevacizumab-maly (Alymsys); billed per 10 mg); Q5118 (biosimilar bevacizumab-bvzr (Zirabev) from Pfizer Inc; billed per 10 mg); Q5107 (biosimilar bevacizumab-awwb (Mvasi) from Amgen Inc; billed per 10 mg); J9035 (billed per 10 mg). The OPPS crosswalk maps 2 NDCs to it, sold as Avastin by Genentech, Inc. 2 Medicare coverage articles list the code across 11 states, including A52370.

Medicare payment: OPPS rate (no ASP limit)

C9257 does not appear in the October 2026 Part B ASP payment limit file. CMS pays it separately to hospital outpatient departments under OPPS with status indicator K in APC 1281, at a national unadjusted rate of $1.887 per 0.25 MG. Status K is a separately paid, non-pass-through drug or biological, including therapeutic radiopharmaceuticals. In a physician office the Medicare contractor prices the drug, often from invoice; commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 OPPS crosswalk maps 2 NDCs from 1 labeler to C9257. Report the NDC in the claim's drug segment and bill the number of C9257 units that equals the quantity administered divided by 0.25 MG; the last column gives units per full package.

NDCs that crosswalk to C9257
NDCDrug nameLabelerPackage sizeBilling units / package
50242-0060-01AvastinGenentech, Inc.4 × 1400
50242-0061-01AvastinGenentech, Inc.16 × 11600

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for C9257. For practitioners the limit is 10 units per date of service with adjudication indicator 2, a date-of-service policy edit: the limit reflects CMS policy and units above it deny even if split across lines; appeals rarely succeed.

MUE values for C9257 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services102 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital102 Date of Service Edit: PolicyAnatomic Consideration

MUE for C9257 in every setting opens the lookup with this code filled in, next to any other code on the same claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists C9257 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

The counts above are exposure, not answers for a specific claim. Check C9257 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

C9257 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

2 current Medicare Administrative Contractor articles list C9257 in their HCPCS tables, covering 11 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing C9257
ArticleTitleContractor(s)StatesRelated LCD
A52370Billing and Coding: Bevacizumab and biosimilarsWellpoint FederalCT IL MN NY WIL33394
A53008Billing and Coding: Intraocular BevacizumabNoridian Healthcare Solutions, LLCAZ MT ND SD UT WY—

Local coverage policies that list C9257

1 active Local Coverage Determination lists C9257 in the policy or in its billing and coding article. Each applies only in its contractor's jurisdiction; check the one for the state where the drug is administered.

Hospital outpatient (OPPS) status

In the October 2026 OPPS Addendum B, C9257 carries status indicator K and is assigned to APC 1281, with a published national unadjusted payment of $1.887. Status K means the drug is paid separately under OPPS rather than packaged into the procedure.

Ambulatory surgical center (ASC) payment

In the October 2026 ASC Addendum BB (covered ancillary services), C9257 carries payment indicator K2, which CMS defines as "Drugs, biologicals, and radiopharmaceuticals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate". The national ASC payment is $1.89 per 0.25 MG, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for C9257 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks C9257 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current OPPS NDC-HCPCS crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS C9257

What does HCPCS code C9257 describe?

C9257 is defined by CMS as "Injection, bevacizumab, 0.25 mg". Each billing unit represents 0.25 MG, so the units reported on the claim must equal the dose administered divided by that unit.

Is C9257 a CPT code?

No. C9257 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as bevacizumab (Avastin); CPT codes are five-character codes maintained by the AMA. On a Part B claim C9257 reports the drug itself in 0.25 mg units, and the administration is billed on its own line.

What does Medicare pay for C9257 in a hospital outpatient department?

C9257 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status K, APC 1281, at $1.887 per 0.25 MG, and ASC Addendum BB gives it payment indicator K2 at $1.89.

How many units of C9257 can be billed per day?

The practitioner Medically Unlikely Edit is 10 units per date of service with adjudication indicator 2 (Date of Service Edit: Policy). MAI 2 edits are policy limits and are rarely overturned on appeal. CMS cites "Anatomic Consideration" as the rationale.

Which NDCs map to C9257?

The October 2026 OPPS crosswalk lists 2 NDCs from 1 labeler: Avastin (Genentech, Inc.). For example NDC 50242-0060-01 (package size 4) equals 400 billing units of C9257.

Does C9257 have NCCI bundling edits?

No active practitioner PTP pairs list C9257 as a column-1 or column-2 code in the v323r0 release.

C9257 vs Q5160: what is the difference?

Both are HCPCS Level II codes whose descriptor names bevacizumab. What sets Q5160 apart: biosimilar bevacizumab-nwgd (Jobevne) from Biocon Biologics Inc.; billed per 10 mg. C9257 is billed per 0.25 mg, OPPS rate $1.887, MUE 10; Q5160 is billed per 10 mg, limit $82.139, MUE 230. Report the code whose descriptor matches the product and setting in the record.

C9257 vs Q5129: what is the difference?

Both are HCPCS Level II codes whose descriptor names bevacizumab. What sets Q5129 apart: biosimilar bevacizumab-adcd (Vegzelma) from Celltrion USA, Inc.; billed per 10 mg. C9257 is billed per 0.25 mg, OPPS rate $1.887, MUE 10; Q5129 is billed per 10 mg, limit $21.139, MUE 230. Report the code whose descriptor matches the product and setting in the record.

Which Medicare coverage articles mention C9257?

2 current Billing and Coding Articles in the Medicare Coverage Database list C9257, covering 11 states: A52370 (Billing and Coding: Bevacizumab and biosimilars); A53008 (Billing and Coding: Intraocular Bevacizumab).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B, ASC Addendum BB and the Medicare Coverage Database. Payment limits and rates are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.