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HCPCS P9011 · Level II · P code

P9011: Blood, split unit, 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); 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 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 P9011

Medicare payment
$155.84
OPPS rate, SI R
Coverage code
D
special coverage instructions apply
Facility outpatient MUE
4
MAI 3
OPPS status
SI R
Blood and blood products
NCCI PTP pairs
10
10 hospital outpatient
LCDs and articles
0 / 0

TL;DR

P9011 is a Level II code from the P section (pathology and laboratory services), in use since 1987: "Blood, split unit". Hospital outpatient departments are paid $155.84 for P9011 under status indicator R, APC 9520, minimum unadjusted copayment $31.17 (October 2026 Addendum B). MUE limits for P9011: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data). In the NCCI PTP files v323r0 P9011 appears in 6 practitioner pairs as column 2 and 4 as column 1 (most often with P9032, P9033, P9036), and in 6 hospital outpatient pairs as column 2 and 4 as column 1. P9011 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. HCPCS record: BETOS T1H (lab tests - other (non-Medicare fee schedule)); pricing indicator 52; type of service 0 (whole blood). 1 other active code opens with "Blood"; related codes: P9010, P9016, P9020, P9021.

P9011 descriptor and code status

The October 2026 HCPCS Level II file describes P9011 as “Blood, split unit”. It sits in the P section (pathology and laboratory services), listed with the other P codes.

HCPCS file attributes of P9011
FieldValue
Short descriptorBlood split unit
Added to HCPCS1987-01-01
Last actionN (no maintenance), effective 2007-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator52: reasonable charge
BETOS categoryT1H: lab tests - other (non-Medicare fee schedule)
Type of service0: whole blood

Medicare payment for P9011

Hospital outpatient departments are paid $155.84 for P9011 under status indicator R, APC 9520, minimum unadjusted copayment $31.17 (October 2026 Addendum B). 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 E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator R (Blood and blood products), APC 9520, national unadjusted payment $155.84 with a minimum unadjusted copayment of $31.17.

Medically Unlikely Edits for P9011

MUE limits for P9011: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data). The facility outpatient MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for P9011 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital43 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for P9011 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, P9011 is the column-2 (bundled) code in 6 active pairs, 100% of which allow a modifier and the column-1 code in 4 (25% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with P9011 (practitioner)
Column-1 codePairs
P9032 Platelets, irradiated1
P9033 Platelets leukoreduced irrad1
P9036 Platelet pheresis irradiated1
P9037 Plate pheres leukoredu irrad1
P9038 Rbc irradiated1
P9040 Rbc leukoreduced irradiated1
Column-2 codes bundled into P9011 (practitioner)
Column-2 codePairs
P9010 Whole blood for transfusion1
P9021 Red blood cells unit1
P9022 Washed red blood cells unit1
P9039 Rbc deglycerolized1

In the hospital outpatient PTP file v323r0, P9011 is the column-2 (bundled) code in 6 active pairs, 100% of which allow a modifier and the column-1 code in 4 (25% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with P9011 (hospital outpatient)
Column-1 codePairs
P9032 Platelets, irradiated1
P9033 Platelets leukoreduced irrad1
P9036 Platelet pheresis irradiated1
P9037 Plate pheres leukoredu irrad1
P9038 Rbc irradiated1
P9040 Rbc leukoreduced irradiated1
Column-2 codes bundled into P9011 (hospital outpatient)
Column-2 codePairs
P9010 Whole blood for transfusion1
P9021 Red blood cells unit1
P9022 Washed red blood cells unit1
P9039 Rbc deglycerolized1

P9011 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 P9011 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for P9011

No current LCD or billing and coding article lists P9011. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on P9011

CARC 50 · N115

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

CARC 151 · N362

units of P9011 exceed the facility outpatient MUE of 4 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 P9011 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for P9011 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 P9011

What does HCPCS code P9011 describe?

"Blood, split unit" (short descriptor "Blood split unit"), in the P section (pathology and laboratory services). Added 1987-01-01; last action N (no maintenance) effective 2007-01-01.

Is P9011 a CPT code?

No: CMS maintains P9011 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for P9011?

Hospital outpatient departments are paid $155.84 for P9011 under status indicator R, APC 9520, minimum unadjusted copayment $31.17 (October 2026 Addendum B).

How many units of P9011 can be billed per day?

MUE limits for P9011: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data). For the facility outpatient MUE (MAI 3), units above 4 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover P9011?

P9011 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.