Billing - General Questions
- What changes have been made to the HCPC File regarding Albumin that will have an impact on ESRD claims?
- Is Albumin separately billable?
- Are there guidelines to follow before Albumin can be billed separately?
- Are there restrictions for Albumin payment?
- Can Albumin be used as a volume expander?
- What are the HCPC codes and descriptions for Albumin?
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The HCPC file in FISS has been updated to allow Albumin to be billed on an ESRD claim.
Date Posted: 12/23/2003, Date Reviewed/Revised: 09/23/2008
Is Albumin separately billable?
In some cases additional reimbursement may be warranted with the proper documentation of medical necessity. Refer to End Stage Renal Disease (ESRD) Training Guide, ESRD Coverage Guidelines, Separately Billable Drugs and CMS Publication 100-2, Chapter 11, Section 30.4.2.
Date Posted: 12/23/2003, Date Reviewed/Revised: 09/23/2008
Are there guidelines to follow before Albumin can be billed separately?
Albumin may be billed separately when it is reasonable and medically necessary for the treatment of certain medical complications in renal dialysis patients. In these cases, the facility must document the medical necessity to allow separate payment for the Albumin in addition to the facility’s composite rate.
Date Posted: 12/23/2003, Date Reviewed/Revised: 09/23/2008
Are there restrictions for Albumin payment?
Yes, documentation to support the diagnosis and medical necessity are required in the medical record and must be available to Highmark Medicare Services upon medical record request.
Date Posted: 12/23/2003, Date Reviewed/Revised: 09/23/2008
Can Albumin be used as a volume expander?
If albumin is used as a substitute for any drug covered under the composite rate, or used to accomplish the same effect, i.e. as a volume expander, then payment for albumin is included in the facility’s composite rate payment for maintenance dialysis and no additional payment should be made.
Date Posted: 12/23/2003, Date Reviewed/Revised: 09/23/2008
What are the HCPC codes and descriptions for Albumin?
The HCPC descriptions for albumin are :
P9041 - Infusion, Albumin, (HUMAN) 5%, 50 ML
P9045 - Infusion, Albumin, (HUMAN), 5 %, 250 ML
P9046 - Infusion, Albumin (HUMAN), 25%, 20ML
P9047 - Infusion, Albumin (HUMAN), 25%, 50 MLDate Posted: 12/23/2003, Date Reviewed/Revised: 09/23/2008
References
- CMS Publication 100-2, Chapter 11 Section 30.4.2 - Separately Billable Drugs
- CMS Publication 100-4, Chapter 8 Section 60.2.1 - Billing Procedures for Drugs for Facilities Section 60.2.2 Drug Payment Amounts for Facilities
- End Stage Renal Disease (ESRD) Specialty Guide