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HCPCS P9046 · Level II · Part B drug

HCPCS P9046: Infusion, albumin (human), 25%, 20 ml

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for P9046

Billing unit
20 ML
Albumin (human), 25%, 20 ml
ASP payment limit
$21.33
October 2026; +0.0% vs July 2026
Practitioner MUE
25
MAI 3
OPPS status
SI K
APC 0964
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS P9046 is the Level II code for Infusion, albumin (human), 25%, 20 ml, billed per 20 ML. The Medicare Part B ASP payment limit for October 2026 is $21.33 per billing unit, up 0.0% from July 2026. The practitioner MUE allows up to 25 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 0964. P9046 is billed in units of 20 ML; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. No current Billing and Coding Article lists P9046, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for P9046 at $21.33 per 20 ML for October 2026, derived from manufacturer average sales price plus 6%, compared with $21.33 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for P9046
QuarterPayment limitPerCoinsurance
October 2026$21.3320 ML20%
July 2026$21.3320 ML—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk lists no NDC for P9046. Report the NDC from the product label and confirm the units conversion from the HCPCS descriptor (Infusion, albumin (human), 25%, 20 ml).

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for P9046. For practitioners the limit is 25 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for P9046 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services253 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital403 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists P9046 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

P9046 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists P9046 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, P9046 carries status indicator K and is assigned to APC 0964, with a published national unadjusted payment of $21.33. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for P9046 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks P9046 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS P9046

What does HCPCS code P9046 describe?

P9046 is defined by CMS as "Infusion, albumin (human), 25%, 20 ml". Each billing unit represents 20 ML, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for P9046 in October 2026?

The ASP-based payment limit is $21.33 per 20 ML, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $21.33.

How many units of P9046 can be billed per day?

The practitioner Medically Unlikely Edit is 25 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: Data" as the rationale.

Does P9046 have NCCI bundling edits?

No active practitioner PTP pairs list P9046 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still 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 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.