Summary & Overview
HCPCS P9045: Infusion of Albumin (Human) 5%, 250 ml
HCPCS Level II code P9045 denotes infusion of human albumin 5% in a 250 ml container, a commonly used plasma volume expander in acute care and infusion settings. Nationally, this code captures a relatively specific supply administered intravenously and is relevant for hospital outpatient departments, infusion centers, and inpatient reporting for albumin product use. Accurate coding of P9045 affects supply tracking, claim processing, and clinical documentation tied to volume replacement therapies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise reference to the clinical context of albumin 5% infusion, typical billing considerations for HCPCS Level II supply codes, and where this item is generally administered. The publication summarizes common modifiers seen with HCPCS supplies, outlines the typical site-of-service implications, and flags areas where further payer-specific coverage rules or prior authorization requirements may apply.
This summary serves clinicians, billing professionals, and policy analysts seeking a national-level reference for HCPCS Level II code P9045, its clinical role, and the payer landscape relevant to reimbursement and claims administration. Data not available in the input where specific payer policy details, associated taxonomies, and ICD-10 mappings would normally be listed.
Billing Code Overview
HCPCS Level II code P9045 represents infusion of human albumin 5% in a 250 ml container. This service is an intravenous plasma volume expander typically used for volume replacement or hypoalbuminemia management.
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Service type: Intravenous infusion of albumin (human) 5%, 250 ml
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Typical site of service: Hospital outpatient infusion center or inpatient hospital setting where intravenous fluids and blood products are administered
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with decompensated cirrhosis is admitted to the hospital with progressive ascites and hypotension following large-volume paracentesis. Laboratory evaluation shows hypoalbuminemia and intravascular volume depletion. The treating hepatology team orders intravenous albumin 5% 250 mL to restore intravascular oncotic pressure and support hemodynamics during and after the procedure. The patient is evaluated by a registered nurse and an infusion-trained clinician in an inpatient acute care setting. Vital signs are monitored prior to infusion, every 15 minutes during the infusion, and upon completion. The infusion is administered via peripheral IV using standard infusion tubing; the infusion and patient response are documented in the electronic medical record, including lot number of product and any adverse reactions. Billing is submitted under HCPCS Level II code P9045 for the single 250 mL albumin infusion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified service | Routine use when no modifier applies and service is billed normally |
22 | Increased procedural services | Use when work or intensity substantially exceeds typical care for the infusion due to complex management |
23 | Unusual procedural service | Use when patient condition makes the administration unusually hazardous |
52 | Reduced services | Use when albumin infusion is partially reduced or truncated for clinical reasons |
59 | Distinct procedural service | Use when P9045 is billed on the same day as another procedure but represents a separate, distinct service |
62 | Two surgeons | Rare for infusions; use when two practitioners of different specialties are required for administration or management |
78 | Return to operating room for a related procedure following initial procedure | Use only if infusion was part of a perioperative complication requiring re-operation |
80 | Assistant surgeon | Use when an assistant surgeon provides documented assistance relevant to the infusion during an operative procedure |
82 | Assistant surgeon (when a qualified resident is not available) | Use when an assistant surgeon is required and no resident is available |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when a PA/NP documents assistant role related to a procedure where infusion is part of operative management |
JW | Drug discarded/partially used | Use when portion of a multi-dose albumin vial is discarded and documentation supports wastage billing constraints |
JZ | Drug not administered to the patient | Use when billed in error or documentation shows product was not infused (typically denied) |
CR | Catastrophic or disaster-related | Use when service is related to a declared catastrophe and payer allows this modifier |
QK | Medical direction of two to four qualified technicians | Use when medical direction applies to infusion administration with multiple technicians |
QX | Service performed under an assistant-at-surgery arrangement by a PA | Use when a PA performs an assistive role documented for a related surgical episode |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080P0207X | Internal Medicine | Hospitalists and internists frequently order and manage albumin infusions for hypoalbuminemia and volume management |
207RC0000X | Gastroenterology | Hepatologists manage cirrhosis-related indications for albumin, including post-paracentesis replacement |
363A00000X | Critical Care Medicine | Intensivists administer albumin for hemodynamic support in critically ill patients |
207L00000X | Emergency Medicine | Emergency physicians may initiate albumin infusions for acute volume resuscitation in the ED |
213E00000X | Anesthesiology | Anesthesiologists may order or oversee albumin during perioperative fluid management |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E83.39 | Other disorders of plasma-protein metabolism | Hypoalbuminemia and plasma protein disorders indicating need for albumin replacement |
K70.30 | Alcoholic cirrhosis of liver without ascites | Chronic liver disease leading to low albumin and potential need for infusion |
K76.6 | Portal hypertension | Complication of liver disease associated with ascites and post-paracentesis albumin replacement |
R60.0 | Localized edema | Edema from hypoalbuminemia where albumin infusion may be used as part of management in select cases |
R60.1 | Generalized edema | Severe hypoalbuminemia-related anasarca where albumin can be indicated to mobilize intravascular volume |
N17.9 | Acute kidney failure, unspecified | In hepatorenal syndrome or acute kidney injury, albumin is often used diagnostically and therapeutically |
I95.9 | Hypotension, unspecified | Hemodynamic instability where albumin may be used as a plasma expander to support blood pressure |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Pre-infusion labs (basic metabolic panel, albumin level) are collected prior to P9045 administration to guide therapy |
36561 | Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older, with subcutaneous port or pump (replacement) | Central venous access placement may be performed when peripheral access is inadequate for albumin or concurrent infusions |
96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | Represents the infusion administration service that may accompany P9045 for reporting infusion time and nursing administration when payer policy requires CPT reporting |
36410 | Venous catheterization, for renal dialysis (but commonly used for other large-bore access) | Large-bore venous access may be used in selected patients receiving albumin during complex resuscitation |
99223 | Initial hospital care, typically 70 minutes or more | Hospital admission evaluation that may include decision to administer albumin and document medical necessity |