Summary & Overview
HCPCS Level II C9134: Factor XIII (recombinant) Tretten, per 10 I.U.
HCPCS Level II code C9134 denotes recombinant Factor XIII (antihemophilic factor, Tretten) measured per 10 international units. This biologic product is used for replacement therapy in patients with congenital or acquired Factor XIII deficiency and is an important, specialized therapy within hemophilia and coagulation disorder management. Nationally, availability and appropriate coding for high-cost biologics like this affect access, coverage determinations, and claims processing workflows for specialty infusion services.
Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of the clinical context for use of C9134, typical sites of service, and which payers are commonly involved in coverage and reimbursement for recombinant coagulation factor therapy. The publication also provides benchmarking and policy-oriented content, including reimbursement benchmarks, coding guidance, and recent policy updates relevant to high-cost biologic infusions. Clinical considerations related to Factor XIII replacement therapy and administrative implications for billing teams and specialty pharmacies are covered to inform coding accuracy and payer communications.
Billing Code Overview
HCPCS Level II code C9134 represents Factor XIII (antihemophilic factor, recombinant), Tretten, per 10 I.U. This code describes a recombinant clotting factor product used in replacement therapy for deficiency of coagulation factor XIII.
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Service type: Prescription biologic replacement therapy (recombinant coagulation factor administration)
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Typical site of service: Infusion or injection in outpatient infusion centers, hospital outpatient departments, physician offices, or ambulatory care settings
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Clinical & Coding Specifications
Clinical Context
A typical patient is a pediatric or adult with congenital Factor XIII deficiency presenting with recurrent bleeding, poor wound healing, or prolonged bleeding after surgery. The clinical workflow begins with hematology diagnosis via Factor XIII activity assays confirming deficiency. A prescription for recombinant Factor XIII concentrate, C9134 (Factor XIII, recombinant, Tretten) per 10 IU, is written by the hematologist. Infusion is administered in an outpatient infusion center, hospital infusion suite, or occasionally at home by trained home infusion nurses. Pre-infusion verification includes patient identity, indication, weight-based dosing calculation, review of allergies, venous access assessment, and baseline vital signs. The pharmacy compounds or dispenses the correct dose (units converted from IU) and prepares appropriate documentation for billing using C9134. During infusion, nurses monitor for infusion reactions and record vitals. Post-infusion documentation includes lot numbers, administered units, time, and any adverse events. Follow-up includes periodic Factor XIII activity monitoring and scheduling of prophylactic or perioperative dosing as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When another therapeutic infusion or service on the same day is distinct and separate from administration of . |