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HCPCS P2038 · Level II · P code

P2038: Mucoprotein, blood (seromucoid) (medical necessity procedure), 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 P2038

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

P2038 is a Level II code from the P section (pathology and laboratory services), in use since 1986: "Mucoprotein, blood (seromucoid) (medical necessity procedure)". The 2026 Q4 clinical laboratory fee schedule pays P2038 $4.95 (national limitation amount). Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy). P2038 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. 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 21; type of service 5 (diagnostic laboratory). Nearby codes: P2033, P2029, P2028, P3000.

P2038 descriptor and code status

The October 2026 HCPCS Level II file describes P2038 as “Mucoprotein, blood (seromucoid) (medical necessity procedure)”. It sits in the P section (pathology and laboratory services), listed with the other P codes.

HCPCS file attributes of P2038
FieldValue
Short descriptorBlood mucoprotein
Added to HCPCS1986-01-01
Last actionN (no maintenance), effective 1993-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator21: clinical lab fee schedule, subject to the national limitation amount
BETOS categoryT1H: lab tests - other (non-Medicare fee schedule)
Type of service5: diagnostic laboratory

Medicare payment for P2038

The 2026 Q4 clinical laboratory fee schedule pays P2038 $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)

P2038 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 P2038

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy). 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 P2038 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 P2038 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists P2038 in v323r0.

P2038 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 P2038 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for P2038

No current LCD or billing and coding article lists P2038. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on P2038

CARC 50 · N115

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

CARC 151 · N362

units of P2038 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 information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for P2038 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for P2038 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 P2038

What does HCPCS code P2038 describe?

"Mucoprotein, blood (seromucoid) (medical necessity procedure)" (short descriptor "Blood mucoprotein"), in the P section (pathology and laboratory services). Added 1986-01-01; last action N (no maintenance) effective 1993-01-01.

Is P2038 a CPT code?

No. P2038 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for P2038?

The 2026 Q4 clinical laboratory fee schedule pays P2038 $4.95 (national limitation amount).

How many units of P2038 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, CMS Policy); hospital outpatient 1 (MAI 2, CMS Policy). 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 P2038?

P2038 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

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.