Summary & Overview
HCPCS J2513: Pentastarch 10% Injection, 100 ml
HCPCS Level II code J2513 denotes a 100 ml injection of pentastarch 10%, a colloid intravenous volume expander used in acute volume resuscitation. Nationally, this code matters for facility and inpatient billing where colloid solutions are administered, influencing drug supply use, coverage determinations, and reimbursement for injectable resuscitation products.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for pentastarch administration, common sites of service where J2513 is billed, and what to expect in payer coverage patterns and billing practice. The publication outlines typical service line placement for this injectable therapy and summarizes common modifier usage and documentation themes where available.
The report provides benchmarks and policy-relevant points for national stakeholders: which payers commonly process claims for colloid infusions, typical clinical scenarios prompting use, and areas where local medical policy or prior authorization may affect utilization. Data not available in the input is noted where applicable. This summary equips revenue cycle, pharmacy, and clinical leadership with concise context about HCPCS Level II code J2513 and its role in acute care billing.
Billing Code Overview
HCPCS Level II code J2513 describes an injection of pentastarch, 10% solution, 100 ml. This code represents administration of a volume expander solution used for intravascular volume support.
Service type: intravenous therapeutic injection (colloid volume expansion)
Typical site of service: hospital inpatient, emergency department, or other acute care settings where intravenous volume resuscitation is provided
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult hospitalized for acute hypovolemia or significant intravascular volume depletion due to trauma, major surgery with blood loss, or severe sepsis with capillary leak. The patient has clinical signs of inadequate perfusion (tachycardia, hypotension, low urine output) and the care team elects to administer a colloid volume expander. A 100 mL vial of J2513 (pentastarch 10% solution) is prepared in the inpatient or perioperative setting by nursing or pharmacy under sterile conditions. The infusion is administered via a peripheral or central intravenous line with continuous monitoring of vital signs, fluid balance, and hemodynamic response. Documentation includes indication for colloid therapy, volume administered, lot number, infusion start and stop times, patient response, and any adverse reactions. Billing uses J2513 per 100 mL vial; applicable facility or professional modifiers are appended per payer and clinical circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when administration required substantially greater resource use due to complexity (document rationale). |