2025 HCPCS code P9038
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Services - Blood and Blood Products, with Associated Procedures P (Pathology and Laboratory) Feed
This HCPCS code represents each unit of red blood cells irradiated before transfusion to prevent transfusion-associated graft-versus-host disease.
Modifiers may apply depending on the circumstances of service.Consult the CMS National Correct Coding Initiative (NCCI) edits for specific guidance.
Medical necessity for code P9038 is established when a patient is at high risk of developing transfusion-associated graft-versus-host disease (GvHD).This risk is significantly elevated in immunocompromised patients, such as those undergoing bone marrow transplantation, organ transplantation, or those with congenital or acquired immunodeficiencies.The irradiation of red blood cells is a preventative measure to mitigate this risk and is therefore considered medically necessary in these high-risk scenarios.
The clinical responsibility lies with the physician or other qualified healthcare professional ordering and overseeing the irradiation and subsequent administration (if applicable) of the red blood cell unit. This includes ensuring appropriate patient selection, ordering the irradiation, verifying the proper handling and storage of the blood product, and ultimately, overseeing the safe transfusion if this is part of the overall treatment plan.The laboratory personnel are responsible for the technical aspects of the irradiation process, following established protocols and quality control measures.
In simple words: This code is for a unit of red blood cells that has been treated with ultraviolet light to make it safe for transfusion. This special treatment helps prevent the donated blood from harming the patient's body.The code is for the blood itself, not for actually giving the blood to the patient.
HCPCS code P9038 reports each unit of red blood cells that have been exposed to ultraviolet radiation prior to administration to a patient undergoing a transfusion.This irradiation is a crucial step in preventing transfusion-associated graft-versus-host disease (GvHD), a serious complication where donor cells attack the recipient's body.The process typically involves separating plasma from red blood cells using centrifugation, adding an anticoagulant to preserve the cells, and then irradiating the red blood cells. This procedure is particularly beneficial for immunocompromised patients with weakened immune systems. A unit of blood is approximately 450 ml (about a pint).Note that this code covers the supply of the irradiated unit; separate codes (such as 36430-36460) are used for the administration of the transfusion itself.For proper reimbursement, report P9038 multiplied by the total number of units the patient receives. If leukoreduction was also performed, use code P9040 instead.
Example 1: A patient with a history of bone marrow transplant requiring a red blood cell transfusion.Irradiation is necessary to prevent graft-versus-host disease., An immunocompromised patient with severe anemia receiving a red blood cell transfusion. Irradiation is used as a prophylactic measure to minimize the risk of GvHD., A patient with a known history of previous blood transfusions needing another transfusion. Irradiation is a precautionary measure in this context.
Complete patient history, including previous transfusions and immune status; physician's order specifying irradiation of the red blood cell unit; laboratory reports confirming irradiation and quality control procedures; documentation of the transfusion itself (if applicable) including the volume transfused and the patient's response.
** Payers may use this code to represent both the product and the collection, processing, transportation, and storage of the irradiated red blood cells.Always refer to the most current payer guidelines for specific reimbursement policies.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a supply code, not a procedure code.
- Specialties:Hematology, Oncology, Transfusion Medicine
- Place of Service:Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center