Summary & Overview
HCPCS C9132: Prothrombin Complex Concentrate (Kcentra), per IU of Factor IX Activity
HCPCS Level II code C9132 represents prothrombin complex concentrate (human), marketed as Kcentra, billed per international unit of factor IX activity. This code captures administration of a concentrated clotting factor product used for urgent reversal of coagulopathy and replacement of vitamin K–dependent factors, making it clinically significant for acute bleeding management and anticoagulation reversal nationally. Payers assessed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code covers clinically and operationally, how major payers approach coverage, and what benchmarks and policy considerations apply to billing and utilization of high-cost, hospital-administered hemostatic agents. The summary provides context on typical sites of service—hospital inpatient, emergency department, and infusion or outpatient procedural settings—and highlights that reimbursement and billing practices hinge on per-unit dosing tied to factor IX activity. The report addresses payment benchmarks, coverage policies, clinical indications reflected in payer guidance, and documentation expectations for billing. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C9132 describes prothrombin complex concentrate (human), Kcentra, billed per international unit of factor IX activity. This product is a concentrated plasma-derived therapy used to provide vitamin K–dependent clotting factors for rapid reversal of coagulopathy.
Service Type: Hemostatic agent / Factor concentrate administration
Typical Site of Service: Hospital inpatient or outpatient settings, emergency departments, and infusion centers where acute reversal of anticoagulation or replacement of clotting factors is required.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male on chronic warfarin therapy presents to the emergency department with acute major gastrointestinal bleeding and an international normalized ratio (INR) of 5.8. Rapid reversal of vitamin K–dependent clotting factors is required to control hemorrhage and permit endoscopic intervention. The treating team administers C9132 (prothrombin complex concentrate [human], Kcentra, per international unit of factor IX activity) per weight-based dosing in the ED or inpatient setting. Concurrent steps in the clinical workflow include bedside assessment, laboratory confirmation of coagulopathy (INR, CBC), ordering weight-based PCC dosing, intravenous access placement, infusion of PCC with concurrent or subsequent intravenous vitamin K, monitoring for thrombotic complications, and arranging definitive hemostatic control such as endoscopy or interventional radiology. Typical sites of service include the emergency department, inpatient hospital ward, intensive care unit, and perioperative settings where urgent reversal of warfarin or other vitamin K antagonist effects is needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when administration required substantially greater resources or complexity than usual (document justification). |