HCPCS code P9047 – Human albumin 25% infusion

Key takeaways

HCPCS code P9047 covers albumin (human) 25% in a 50 ml vial, billed one unit per vial.

P9046 covers the same 25% albumin in a 20 ml vial, so check the vial size before you bill.

Total volume divided by 50 gives the unit count, so a 200 ml dose bills as four units.

The claim needs a supported ICD-10 diagnosis, a recent serum albumin result, and the product’s NDC.

Medicare prices P9047 from the quarterly ASP file, and many commercial plans require prior authorization.

HCPCS code P9047 bills one unit per 50 ml vial

HCPCS code P9047 bills one unit for every 50 ml vial of albumin (human) 25% administered. The official CMS descriptor reads “infusion, albumin (human), 25%, 50 ml.” Give 100 ml and you bill two units.

The code is active for fiscal year 2026 with no deletion scheduled, according to the AAPC HCPCS Level II code database.

Albuked 25 is the best-known branded product billed under P9047. Other 25% albumin products supplied in a 50 ml vial map to the same code, whoever makes them. So the check is always volume. A 50 ml vial takes P9047, and a 20 ml vial takes P9046.

When 25% albumin counts as medically necessary

Payers accept P9047 when the record shows a documented need for oncotic pressure support, volume restoration, or albumin replacement. At 25%, albumin is hyperoncotic relative to plasma. That makes it the choice when fluid restriction matters, and it separates the product from the 5% formulation used for volume expansion.

CMS and most Medicare Administrative Contractor (MAC) Local Coverage Determinations recognize these indications as supportable for P9047 claims:

• Hypoalbuminemia with serum albumin below payer-specified thresholds (commonly below 2.0-2.5 g/dL), particularly when other nutritional interventions are contraindicated
• Cirrhosis with large-volume paracentesis (ascites requiring removal of 5 liters or more), where albumin reduces the risk of paracentesis-induced circulatory dysfunction
• Spontaneous bacterial peritonitis (SBP) in cirrhotic patients, where albumin reduces renal impairment risk
• Hepatorenal syndrome when used in combination with vasoconstrictors
• Burns involving large total body surface area where plasma oncotic pressure is compromised
• Nephrotic syndrome with severe symptomatic edema and hypoalbuminemia unresponsive to diuretics

Each MAC sets its own serum albumin thresholds and clinical criteria. So check the applicable LCD before you bill P9047 for a diagnosis that sits outside the groupings above.

Vial size is the only difference between P9046 and P9047

P9046 covers the same 25% albumin, supplied in a 20 ml vial. P9047 covers it in a 50 ml vial. Volume per unit is the difference, and it is a fixed product specification. Submit the wrong code and the claim mismatches the payer’s drug database automatically.

Count units from the 50 ml vials pulled from stock and administered. A 200 ml infusion order equals four units. Cross-referencing the pharmacy dispensing record against the infusion administration note prevents most unit-count mismatches at claims edit. The chart below puts both checks side by side.

The diagnosis code decides whether P9047 gets paid

A P9047 claim pays only when the diagnosis on it supports the infusion. The supporting code has to reflect the clinical reason for the albumin order. It also has to meet the payer’s medical necessity criteria under the applicable LCD.

The diagnoses below come up most often on albumin claims. Each one is drawn from the ICD-10-CM code set and has to be supported by the treating physician’s own documentation.

ICD-10-CM changes every fiscal year. So verify each code against the current release in the CDC/NCHS ICD-10-CM web tool before you submit. Where a MAC publishes a covered-diagnosis list inside its albumin LCD, that list wins.

Pair P9047 with the CPT code for the infusion

P9047 codes the albumin product only. The administration service is captured separately under CPT, and in most outpatient settings both belong on the same claim.

Drop the companion CPT code and you lose the administration revenue. You also invite a medical necessity review on the product, because payers expect to see the service that used it.

Common companion codes, with the context each one fits:

• CPT 96365 – Intravenous infusion for therapy, prophylaxis, or diagnosis: initial, up to 1 hour. Use it as the initial infusion service when albumin is the first or only drug infused during the encounter.
• CPT 96366 – Each additional hour of IV infusion, reported as an add-on to 96365. Report it for each additional hour of the same albumin infusion beyond the first.
• CPT 36430 – Transfusion, blood or blood components. Used in inpatient settings where albumin is classified administratively as a blood component transfusion. Context and payer contract decide which CPT applies.
• CPT 96374 – Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance. It applies when the albumin goes in as a push rather than a drip, which is atypical at high volumes.

Under hospital outpatient prospective payment system (OPPS) billing, the facility bills the product and the CPT captures the professional administration. Under buy-and-bill, the physician practice reports both P9047 and the companion CPT on the same 1500 claim form.

Pre-mapping the pairings for each clinical scenario helps front-line staff pick the right combination at encounter closure.

Coverage shifts with the payer and the place of service

Medicare Part B covers P9047 under its physician-administered drug benefit, provided the infusion meets documented medical necessity criteria. Coverage is not automatic.

The claim has to carry a supported ICD-10 diagnosis, and the record has to show a physician order and a Medicare-participating setting.

Key coverage points by payer type:

• Medicare Part B (physician office/outpatient): Covered under the ASP payment methodology. MACs may publish albumin-specific LCDs listing covered diagnoses and serum albumin thresholds. Confirm the LCD for your MAC jurisdiction before billing.
• Medicare Part A (inpatient hospital): Albumin costs are typically bundled into the DRG payment. Separate Part A billing for P9047 is generally not appropriate in inpatient settings.
• Medicaid/Medi-Cal: Medi-Cal’s Blood and Blood Derivatives provider manual includes P9047 as a covered blood derivative code. State Medicaid programs set their own policies, so verify the specific state’s rules first.
• Commercial payers: Most commercial plans cover albumin infusion for the same indications as Medicare, but many require prior authorization. Some restrict coverage to inpatient settings.

Practices that infuse across several sites of service carry the most risk here. The same patient can be covered in one setting and denied in another, so confirm coverage per encounter rather than per patient.

Medicare prices P9047 from the quarterly ASP file

CMS pays physician-administered Part B drugs using the Average Sales Price (ASP) methodology. For P9047 in a physician office, the rate is ASP plus 6%, and CMS updates it quarterly.

Hospital outpatient payment runs through Ambulatory Payment Classification (APC) packaging rules, which can bundle the product into the facility APC instead of paying it separately.

Because ASP rates move every quarter, any dollar figure printed in an article is a historical reference point.

Check the current rate in the CMS Physician Fee Schedule lookup tool, or in the quarterly ASP drug pricing file, before you submit. Contracted commercial rates can sit well away from the Medicare rate.

Read the remittance once payment posts. It is the quickest way to see whether the payer paid at the expected ASP rate, or applied a contractual adjustment worth appealing.

Prior authorization rules vary from payer to payer

Prior authorization (PA) for P9047 depends on the plan. Medicare Part B does not universally require it for albumin infusions. Individual MACs and commercial plans often do, especially for outpatient or home-infusion settings where the clinical urgency is less obvious to a reviewer.

Build a PA check for blood derivatives into the eligibility verification you run before every P9047 encounter. A PA request usually has to carry:

• Current serum albumin level with the date of the lab draw
• Primary ICD-10-CM diagnosis code and a clinical narrative justifying medical necessity
• Treating physician’s attestation that alternative therapies were attempted or are contraindicated
• Proposed dose, volume per administration, and treatment frequency
• Site of service where the infusion will occur
• NDC number (National Drug Code) for the specific albumin product being used

Record the authorization number in the billing record once a PA is granted, and reference it on the claim. A denied PA still has a route forward. Most payers offer an appeals pathway, and peer-to-peer review with the medical director works well when the clinical criteria are documented.

What an auditor expects to find in the chart

Every element supporting a P9047 claim has to sit in the medical record before you submit. An auditor looks for a complete, contemporaneous infusion record that corroborates each field on the claim form.

The minimum documentation set for a compliant P9047 claim:

• Physician order: A signed, dated order specifying albumin (human) 25%, the volume per dose, and the infusion frequency
• Serum albumin lab value: A recent result, typically within 30 days or per the MAC LCD requirement, with the date and the result in g/dL
• Infusion administration record: Start and stop time, volume infused, lot number, and NDC of the product administered
• Supporting diagnosis: The primary ICD-10-CM code for the condition necessitating albumin, as documented by the treating physician
• Site of service: Must match the place-of-service code on the claim, whether office, outpatient hospital, or infusion center
• Medical necessity statement: A clinical note explaining why concentrated 25% albumin was selected over lower-concentration alternatives

Keep that set in a structured, retrievable format. It supports the first submission and any post-payment audit that follows, and it shortens days in accounts receivable on high-cost blood product codes.

How a P9047 claim moves from order to payment

The claim form itself is short. Almost all of the work happens before it leaves the practice, across six handoffs:

1. The physician orders albumin (human) 25%, naming the volume per dose and the frequency.
2. The front office verifies eligibility and checks whether the plan requires prior authorization for blood derivatives.
3. Pharmacy dispenses the vials and records the vial size, the lot number, and the NDC.
4. Nursing administers the infusion and documents start time, stop time, and volume infused.
5. Charge entry converts total volume to units, selects P9047, and adds the companion CPT code.
6. Billing submits with the supporting diagnosis and the NDC, then posts the remittance and works any denial.

Claims break at the handoffs, not inside any one step. The pharmacy record, the administration note and the charge line all have to agree on the same vial count.

The denials that repeat, and the checks that stop them

P9047 denials cluster around a short list of errors, and most are preventable at charge entry. Four checks catch the bulk of them. Verify the code, the unit count, the ICD-10 pairing, and the PA status.

Before you submit, run down this list:

• The vial size on the dispensing record matches the code you selected
• Total volume divided by 50 matches the unit count on the claim line
• The primary diagnosis appears on the payer’s covered-diagnosis list
• A serum albumin result sits in the record, dated inside the MAC’s recency window
• The prior authorization number is on file where the plan requires one
• The NDC and the place-of-service code match the product given and the site used

Track denials at the code level rather than in aggregate. The CARC and RARC codes on the remittance show whether a pattern comes from coder error, thin documentation, or a payer policy change. Fix the cause, then resubmit a corrected claim or appeal inside the filing window.

How practice software keeps P9047 claims moving

Most of the trouble above comes from information sitting in separate systems. The pharmacy log lives in one place, the infusion note in another, and the charge line in a third. Reconciling three sources by hand, encounter after encounter, is where a vial count quietly goes wrong.

Practice management software like Pabau keeps the order, the treatment note, the lab result and the invoice on one patient record. Charge entry then works from the same record the clinician documented in, so nobody rekeys a vial count off a printout.

Pabau’s claims management software submits through an integrated clearinghouse and supports payer-specific billing workflows. Remittances post back against the same record, so an outstanding P9047 claim stays visible to whoever picks up the follow-up.

Keep blood product claims moving to payment

Pabau’s claims management software submits claims through an integrated clearinghouse and supports payer-specific billing workflows. See how one patient record keeps HCPCS billing and remittance posting in step.

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Conclusion

Accurate P9047 billing comes down to four checks before the claim goes out. Confirm the vial is 50 ml, convert total volume to units, pair a supported ICD-10 diagnosis, and confirm the PA status. Those four steps stop most denials before the payer’s edit system ever sees them.

The trade-off worth remembering is timing. Each check costs a minute before the infusion. After a denial, the same work costs several staff hours, because an appeal reopens what the original verification would have finished. So put the checks in the encounter workflow, where they cost the least.

Book a demo to see how Pabau handles HCPCS claim submission, remittance posting and denial follow-up in one place.

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