2025 HCPCS code P9021
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Services - Blood and Blood Products P (Pathology and Laboratory) Feed
This HCPCS code represents one unit of red blood cells for transfusion.
Modifiers may apply depending on the specific circumstances.Consult the most current HCPCS and payer guidelines.
Medical necessity for red blood cell transfusion is established based on the patient's clinical condition. Low hemoglobin/hematocrit levels, symptoms of anemia (fatigue, weakness, shortness of breath), and the need to maintain adequate oxygen-carrying capacity are critical considerations.Specific medical necessity criteria might vary depending on payer guidelines.
Physicians, nurses, and laboratory personnel are involved in the acquisition, processing, storage, and administration of red blood cells.The physician orders the transfusion and monitors the patient's response.Nursing staff administers the blood products, and laboratory personnel ensure quality control and testing.
In simple words: This code is for one unit of red blood cells given during a blood transfusion. This only covers the cost of the blood itself, not the actual process of giving the blood to the patient.
HCPCS code P9021 denotes a single unit of red blood cells (RBCs) intended for transfusion.A unit typically contains approximately 450ml.The code encompasses the supply of the blood product, but not the administration of the transfusion itself (codes 36430-36460 are used for that purpose).Prior to administration, RBCs may undergo processing steps such as separation from plasma using a centrifuge, addition of anticoagulants to prevent clotting, and the addition of preservation solutions. The product's storage lifespan is up to 42 days.Payers may use this code to represent the product, collection, processing, storage, and transportation.
Example 1: A patient with severe anemia secondary to chronic kidney disease requires a red blood cell transfusion to alleviate symptoms of fatigue and shortness of breath. Code P9021 would be used to bill for each unit of RBCs transfused., A trauma patient with significant blood loss during surgery needs multiple units of red blood cells to restore blood volume and oxygen-carrying capacity.Code P9021 would be billed for each unit transfused., A patient undergoing a major surgical procedure experiences substantial blood loss intraoperatively and postoperatively. In this scenario, several units of red blood cells are transfused to replace the lost blood. Code P9021 would reflect each unit supplied and prepared for transfusion.
Complete blood count (CBC) with differential, blood type and crossmatch results, physician's orders specifying the number of units of red blood cells, documentation of patient's clinical status before, during, and after the transfusion (e.g., vital signs, hemoglobin/hematocrit levels).
** Always cross-reference with the most recent HCPCS codebook and payer guidelines to ensure accurate billing practices.This code is specific to the supply of red blood cells; administration is billed separately.
- Payment Status: Active
- Modifier TC rule: This HCPCS code does not have a technical component (TC) modifier.
- Fee Schedule : Refer to CMS fee schedules and other relevant sources for historical data on reimbursement rates for this HCPCS code.
- Specialties:Hematology, Oncology, Transfusion Medicine, Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center