P9038 HCPCS code: Red blood cells, irradiated, each unit
P9038 is the HCPCS Level II code for red blood cells, irradiated, each unit. In 2023 Medicare paid an average of $224.16 per service for P9038 across 33 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 4 per day on outpatient hospital claims. In 2023, about 12 clinicians billed Medicare for P9038 for 12 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | P codes — Pathology and laboratory services |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 52 |
| BETOS category | T1H |
| Added | 2001-01-01 |
| Last action effective | 2001-01-01 |
Who bills P9038 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 12 |
| Medicare beneficiaries | 12 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for P9038, 2023–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 33 | 12 | $281.34 | $224.16 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Clinical: Data |
| practitioner claims | 2 | Clinical: CMS Workgroup |
What changed for P9038
- 2001-01-01: P9038 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code P9038?
P9038 is the HCPCS Level II code for red blood cells, irradiated, each unit. Short descriptor: "Rbc irradiated".
How much does Medicare pay for P9038?
In 2023, the average Medicare payment was $224.16 per service (average allowed $281.34).
Does Medicare cover P9038?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of P9038 can be billed per day?
4 on outpatient hospital claims; 2 on practitioner claims (NCCI medically unlikely edits).
Related P90 codes
- P9010 — Blood (whole), for transfusion, per unit
- P9011 — Blood, split unit
- P9012 — Cryoprecipitate, each unit
- P9016 — Red blood cells, leukocytes reduced, each unit
- P9017 — Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit
- P9019 — Platelets, each unit
- P9020 — Platelet rich plasma, each unit
- P9021 — Red blood cells, each unit
- P9022 — Red blood cells, washed, each unit
- P9023 — Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit
- P9025 — Plasma, cryoprecipitate reduced, pathogen reduced, each unit
- P9026 — Cryoprecipitated fibrinogen complex, pathogen reduced, each unit
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under P9038
- Watch P9038 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for P9038
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.