Skip to main content
HCPCS C9460 · Level II · Part B drug

C9460: cangrelor (Kengreal), 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 C9460

Billing unit
1 MG
Injection, cangrelor
OPPS payment rate
$20.678
no ASP limit; SI K, October 2026
Practitioner MUE
1
MAI 3
OPPS status
SI K
APC 9460
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS C9460 is the Level II code for Injection, cangrelor, 1 mg, billed per 1 MG. CMS publishes no ASP payment limit for it; hospital outpatient departments are paid separately under OPPS (status indicator K, $20.678 per billing unit in October 2026). The practitioner MUE allows up to 1 units per date of service (MAI 3). With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The OPPS crosswalk maps 1 NDC to it, sold as Kengreal by Chiesi USA, Inc. No current Billing and Coding Article lists C9460, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare payment: OPPS rate (no ASP limit)

C9460 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 9460, at a national unadjusted rate of $20.678 per 1 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 1 NDC from 1 labeler to C9460. Report the NDC in the claim's drug segment and bill the number of C9460 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to C9460
NDCDrug nameLabelerPackage sizeBilling units / package
10122-0620-10KengrealChiesi USA, Inc.1 × 10500

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for C9460. For practitioners the limit is 1 unit per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for C9460 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalClinical: CMS Workgroup
Facility outpatient hospital1003 Date of Service Edit: ClinicalPrescribing Information

MUE for C9460 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 C9460 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 C9460 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

C9460 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists C9460 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the October 2026 OPPS Addendum B, C9460 carries status indicator K and is assigned to APC 9460, with a published national unadjusted payment of $20.678. 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), C9460 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 $20.68 per 1 MG, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for C9460 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 C9460 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.

Explore QuickCodeExplore QuickRCMBook a meeting

In QuickIntell research

Frequently asked questions — HCPCS C9460

What does HCPCS code C9460 describe?

C9460 is defined by CMS as "Injection, cangrelor, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

Is C9460 a CPT code?

No. C9460 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as cangrelor (Kengreal); CPT codes are five-character codes maintained by the AMA. On a Part B claim C9460 reports the drug itself in 1 mg units, and the administration is billed on its own line.

What does Medicare pay for C9460 in a hospital outpatient department?

C9460 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status K, APC 9460, at $20.678 per 1 MG, and ASC Addendum BB gives it payment indicator K2 at $20.68.

How many units of C9460 can be billed per day?

The practitioner Medically Unlikely Edit is 1 units per date of service with adjudication indicator 3 (Date of Service Edit: Clinical). The facility outpatient MUE is 100. MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: CMS Workgroup" as the rationale.

Which NDCs map to C9460?

The October 2026 OPPS crosswalk lists 1 NDC from 1 labeler: Kengreal (Chiesi USA, Inc.). For example NDC 10122-0620-10 (package size 1) equals 500 billing units of C9460.

Does C9460 have NCCI bundling edits?

No active practitioner PTP pairs list C9460 as a column-1 or column-2 code in the v323r0 release.

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.