P9043 — Infusion, plasma protein fraction (human), 5%, 50 ml
P9043 is a HCPCS Level II code for infusion, plasma protein fraction (human), 5%, 50 ml. It belongs to the Pathology and Laboratory Services section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of P9043 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 5 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 10 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for P9043
- Long descriptor
- Infusion, plasma protein fraction (human), 5%, 50 ml
- Short descriptor
- Plasma protein fract,5%,50ml
- Added
- January 1, 2001
- BETOS
- T1H
- Pricing indicator
- 52 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Reasonable charge.
Codes adjacent to P9043
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If P9043 is not quite right, the correct code is very often within a few positions of it.
- P9034Platelets, pheresis, each unit
- P9035Platelets, pheresis, leukocytes reduced, each unit
- P9036Platelets, pheresis, irradiated, each unit
- P9037Platelets, pheresis, leukocytes reduced, irradiated, each unit
- P9038Red blood cells, irradiated, each unit
- P9039Red blood cells, deglycerolized, each unit
- P9040Red blood cells, leukocytes reduced, irradiated, each unit
- P9041Infusion, albumin (human), 5%, 50 ml
- P9044Plasma, cryoprecipitate reduced, each unit
- P9045Infusion, albumin (human), 5%, 250 ml
- P9046Infusion, albumin (human), 25%, 20 ml
- P9047Infusion, albumin (human), 25%, 50 ml
- P9048Infusion, plasma protein fraction (human), 5%, 250 ml
- P9050Granulocytes, pheresis, each unit
- P9051Whole blood or red blood cells, leukocytes reduced, cmv-negative, each unit
- P9052Platelets, hla-matched leukocytes reduced, apheresis/pheresis, each unit
Questions about P9043
What is HCPCS code P9043?
P9043 is a HCPCS Level II code for infusion, plasma protein fraction (human), 5%, 50 ml. It sits in the Pathology and Laboratory Services section.
Does Medicare cover P9043?
The CMS HCPCS file marks P9043 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is P9043 paid under the physician fee schedule?
P9043 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.