`P9045` Albumin (human), 5%, 250 ml

Infusion, albumin (human), 5%, 250 ml

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 20 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 20 units per day (clinical), rationale: Clinical: Data

Medicare pricing for P9045

Medicare Part B drug payment limit (ASP, October 2026)

P9045 payment limit: $53.079 per 250 ML, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%. Paid at 95% of AWP (blood product).

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for P9045

Medicaid fee-for-service

AZ: $50.43 (asc), effective Oct 1, 2024
CO: $40.60 (chp_plus, non-facility), effective Jul 1, 2026
IN: $41.75 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2026
KS: $53.08 (default), effective Apr 1, 2023
KY: $53.08 (asc), effective Jan 1, 2026
MS: $42.46 (comprehensive, facility), effective Oct 1, 2025
NE: $53.07 (injectables), effective Jul 1, 2026
OK: $49.70 (physician, non-facility), effective Jul 1, 2026
TX: $53.08 (physician, Physician, non-facility), effective Mar 1, 2024
VA: $53.07 (medical), effective Oct 1, 2023
VT: $40.34 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $53.08 (kidneycenters), effective Jul 1, 2026
WY: $22.97 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

P9045 Albumin (human), 5%, 250 ml