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HCPCS P9020 · Level II · P code

P9020: Platelet rich plasma, each 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 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; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for P9020

Medicare payment
$559.79
OPPS rate, SI R
Coverage code
D
special coverage instructions apply
Facility outpatient MUE
5
MAI 3
OPPS status
SI R
Blood and blood products
NCCI PTP pairs
7
7 hospital outpatient
LCDs and articles
6 / 6

TL;DR

P9020 is a Level II code from the P section (pathology and laboratory services), in use since 1987: "Platelet rich plasma, each unit". Hospital outpatient departments are paid $559.79 for P9020 under status indicator R, APC 9516, minimum unadjusted copayment $111.96 (October 2026 Addendum B). MUE limits for P9020: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 5 (MAI 3, Clinical: Data). In the NCCI PTP files v323r0 P9020 appears in 7 practitioner pairs as column 2 and 0 as column 1 (most often with G0460, P9032, P9033), and in 7 hospital outpatient pairs as column 2 and 0 as column 1. 6 active LCDs and 6 billing and coding articles list P9020 across 22 states plus DC and 2 territories: L38745 (Platelet Rich Plasma), L38937 (Platelet Rich Plasma), A58282, A58609. HCPCS record: BETOS T1H (lab tests - other (non-Medicare fee schedule)); pricing indicator 52; type of service 9 (other medical items or services). Nearby codes: P9021, P9016, P9011, P9010.

P9020 descriptor and code status

The October 2026 HCPCS Level II file describes P9020 as “Platelet rich plasma, each unit”. It sits in the P section (pathology and laboratory services), listed with the other P codes. Although searches often call it the "P9020 CPT code", P9020 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of P9020
FieldValue
Short descriptorPlaelet rich plasma unit
Added to HCPCS1987-01-01
Last actionN (no maintenance), effective 2001-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator52: reasonable charge
BETOS categoryT1H: lab tests - other (non-Medicare fee schedule)
Type of service9: other medical items or services

Medicare payment for P9020

Hospital outpatient departments are paid $559.79 for P9020 under status indicator R, APC 9516, minimum unadjusted copayment $111.96 (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 9516, national unadjusted payment $559.79 with a minimum unadjusted copayment of $111.96.

Medically Unlikely Edits for P9020

MUE limits for P9020: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 5 (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 P9020 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital53 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for P9020 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, P9020 is the column-2 (bundled) code in 7 active pairs, 100% of which allow a modifier and the column-1 code in 0; 1 earlier pair has 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 P9020 (practitioner)
Column-1 codePairs
G0460 Autolog prp not diab ulcer1
P9032 Platelets, irradiated1
P9033 Platelets leukoreduced irrad1
P9036 Platelet pheresis irradiated1
P9037 Plate pheres leukoredu irrad1
P9038 Rbc irradiated1
P9040 Rbc leukoreduced irradiated1

In the hospital outpatient PTP file v323r0, P9020 is the column-2 (bundled) code in 7 active pairs, 100% of which allow a modifier and the column-1 code in 0; 1 earlier pair has 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 P9020 (hospital outpatient)
Column-1 codePairs
G0460 Autolog prp not diab ulcer1
P9032 Platelets, irradiated1
P9033 Platelets leukoreduced irrad1
P9036 Platelet pheresis irradiated1
P9037 Plate pheres leukoredu irrad1
P9038 Rbc irradiated1
P9040 Rbc leukoreduced irradiated1

P9020 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 P9020 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for P9020

6 active Local Coverage Determinations and 6 billing and coding articles list P9020. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

  • L38745 Platelet Rich Plasma · Palmetto GBA
  • L38937 Platelet Rich Plasma · Wellpoint Federal
  • L39023 Platelet Rich Plasma Injections for Non-Wound Injections · CGS Administrators, LLC
  • L39058 Platelet Rich Plasma Injections for Non-Wound Injections · Noridian Healthcare Solutions, LLC
  • L39068 Platelet Rich Plasma · Novitas Solutions, Inc.
  • L39071 Platelet Rich Plasma · First Coast Service Options, Inc.
Billing and Coding Articles listing P9020
ArticleTitleContractor(s)Related LCD
A58282Billing and Coding: Platelet Rich PlasmaPalmetto GBAL38745
A58609Billing and Coding: Platelet Rich PlasmaWellpoint FederalL38937
A58737Billing and Coding: Platelet Rich Plasma Injections for Non-Wound InjectionsCGS Administrators, LLCL39023
A58788Billing and Coding: Platelet Rich Plasma Injections for Non-Wound InjectionsNoridian Healthcare Solutions, LLCL39058
A58808Billing and Coding: Platelet Rich PlasmaNovitas Solutions, Inc.L39068
A58810Billing and Coding: Platelet Rich PlasmaFirst Coast Service Options, Inc.L39071

Denials to expect on P9020

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists P9020

CARC 151 · N362

units of P9020 exceed the facility outpatient MUE of 5 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 P9020 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for P9020 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 P9020

What does HCPCS code P9020 describe?

"Platelet rich plasma, each unit" (short descriptor "Plaelet rich plasma unit"), in the P section (pathology and laboratory services). Added 1987-01-01; last action N (no maintenance) effective 2001-01-01.

Is P9020 a CPT code?

No: CMS maintains P9020 in HCPCS Level II, while the AMA maintains CPT. People do search "P9020 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for P9020?

Hospital outpatient departments are paid $559.79 for P9020 under status indicator R, APC 9516, minimum unadjusted copayment $111.96 (October 2026 Addendum B).

How many units of P9020 can be billed per day?

MUE limits for P9020: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 5 (MAI 3, Clinical: Data). For the facility outpatient MUE (MAI 3), units above 5 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover P9020?

Coverage code D (special coverage instructions apply). 6 active LCDs and 6 billing and coding articles list P9020 across 22 states plus DC and 2 territories: L38745 (Platelet Rich Plasma), L38937 (Platelet Rich Plasma), A58282, A58609.

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.