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HCPCS P2028 · Level II · P code

P2028: Cephalin floculation, blood, HCPCS Level II P code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); Clinical Laboratory Fee Schedule: 26CLABQ4 (CY2026 Q4) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and Clinical Laboratory Fee Schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for P2028

Medicare payment
$4.95
CLFS national limitation amount
Coverage code
D
special coverage instructions apply
Practitioner MUE
1
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS P2028, added in 1986, as "Cephalin floculation, blood". The 2026 Q4 clinical laboratory fee schedule pays P2028 $4.95 (national limitation amount). CMS caps P2028 at practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy) units per day in the 2026 Q4 MUE tables. No current LCD or billing article lists P2028; its HCPCS coverage code is D (special coverage instructions apply). OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS T1H (lab tests - other (non-Medicare fee schedule)); pricing indicator 57; type of service 5 (diagnostic laboratory). Nearby codes: P2029, P2033, P2038, P3000.

P2028 descriptor and code status

The October 2026 HCPCS Level II file describes P2028 as “Cephalin floculation, blood”. It sits in the P section (pathology and laboratory services), listed with the other P codes.

HCPCS file attributes of P2028
FieldValue
Short descriptorCephalin floculation test
Added to HCPCS1986-01-01
Last actionN (no maintenance), effective 1990-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator57: other contractor-priced
BETOS categoryT1H: lab tests - other (non-Medicare fee schedule)
Type of service5: diagnostic laboratory

Medicare payment for P2028

The 2026 Q4 clinical laboratory fee schedule pays P2028 $4.95 (national limitation amount). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Clinical Laboratory Fee Schedule (26CLABQ4)

P2028 is paid at $4.95 (national limitation amount). Laboratory fee schedule payments carry no beneficiary coinsurance or deductible.

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for P2028

CMS caps P2028 at practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for P2028 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCMS Policy
Facility outpatient hospital12 Date of Service Edit: PolicyCMS Policy

The MUE lookup for P2028 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists P2028 in v323r0.

P2028 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check P2028 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for P2028

No current LCD or billing and coding article lists P2028. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on P2028

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of P2028 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for P2028 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for P2028 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS P2028

What does HCPCS code P2028 describe?

"Cephalin floculation, blood" (short descriptor "Cephalin floculation test"), in the P section (pathology and laboratory services). Added 1986-01-01; last action N (no maintenance) effective 1990-01-01.

Is P2028 a CPT code?

It is not. P2028 belongs to the P section (pathology and laboratory services) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for P2028?

The 2026 Q4 clinical laboratory fee schedule pays P2028 $4.95 (national limitation amount).

How many units of P2028 can be billed per day?

CMS caps P2028 at practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover P2028?

No current LCD or billing article lists P2028; its HCPCS coverage code is D (special coverage instructions apply).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.