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This typical document outlines Medicare reimbursement for Blood and Blood related charges in New York. No change in this paper has been made below the red line.

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Billing for Blood Charges
under the Outpatient Prospective Payment System

 The Health Care Financing Administration (HCFA) has addressed the issue of how to bill for charges related to blood in states where the blood product itself is not purchased. The following information is quoted directly from a Q&A on the HCFA Web site, http://www.hcfa.gov/medlearn/faqclaim.htm. This information applies to hospital outpatient services paid under OPPS for dates of service on or after August 1, 2000.

Q. 110. How are we supposed to bill for blood use? Our state doesn’t allow blood to be sold, so we don’t have a charge for blood, only for processing and storage.

A. 110. We have changed the way blood use is shown. We will pay for the administration of blood using code 36430 (billed once per day for all transfusions) in revenue code 391. Bill for blood and blood products using the range of HCPCS codes provided for them, in Revenue Codes 380-389. The charge you show should reflect the charge made by the blood bank (if your hospital purchases blood rather than using an in-house blood bank). We realize that in most cases the charge is not for the blood per se, but rather for the costs associated with recruiting donors, hiring phlebotomists, testing blood for infective agents, and further processing, storage, and transportation. You may also bill the laboratory codes for typing and cross matching and other services related to the patient who receives the blood. You may not bill for blood processing and storage, since those costs are captured in the payment rate assigned to the blood or blood product. If your hospital runs its own blood bank, for some or all of the blood you use, you should follow the same process, since if you bill for processing and storage, rather than units of blood, your claims will not be paid. We have inserted an edit so that blood or a blood product must be billed when blood administration is billed. Except in those instances in which blood itself is paid for, the blood deductible is not applied. Fiscal intermediaries will change their revenue code edits to reflect this change.

Billing Instructions

 Administration of blood (transfusion) -- For all providers

Revenue code:    391
HCPCS code:    36430
Units:    One (per day)
Charges:    Charges related to the administration of blood

Blood Product/Storage/Processing

For providers who bill for the blood product (Cannot be used by Connecticut or New York).

Revenue code:    380-389
HCPCS code:    Level II C-codes and P-codes as appropriate for blood product administered
Units: Number of units
Charges: Charges associated with blood products, recruiting donors, hiring phlebotomists, testing blood for infective agents, and further processing, storage, and transportation

Note: Delaware providers should not bill additional lines for blood storage and processing since these costs are captured in the payment rate assigned to the blood or blood product HCPCS code.

For providers who do not bill for the blood product.

Revenue code:    390*
HCPCS code:    Level II C-codes and P-codes as appropriate for blood product administered
Units:    Number of units
Charges:    Charges associated with recruiting donors, hiring phlebotomists, testing blood for infective agents, and further processing, storage, and transportation

*We are clarifying with HCFA whether Revenue Codes 380-389 should be used. Currently we can only accept Revenue Code 390. Additional information will be published as soon as it becomes available.

Additional Billing Information

  • Providers may bill for laboratory codes for typing and cross matching and other services related to the patient who receives the blood.
  • Providers who have submitted outpatient claims for dates of service August 1, 2000 and later may submit adjustments to add the administration of blood.

HCPCS codes Currently Available for Billing Blood

Blood/Blood Products Classified in Separate APCs
(Effective August 1, 2000)

The following list of blood/blood products and drugs are classified in separate APCs. Since these are classified in separate APCs, they are not eligible for the transitional pass-through payment system.

HCPCS Code  Long Description    APC
C1009    Plasma, cryoprecipitate reduced, each unit    1009
C1010    Blood, leukoreduced, CMV-negative, each unit    1010
C1011    Platelet, HLA-matched leukoreduced, apheresis/pheresis, each unit    1011
C1012    Platelet concentrate, leukoreduced, irradiated, each unit    1012
C1013  Platelet concentrate, leukoreduced, each unit    1013
  C1014   Platelet, leukoreduced, apheresis/pheresis, each unit    1014
C1016    Blood, leukoreduced, frozen/deglycerol/washed, each unit    1016
C1017    Platelet, leukoreduced, CMV-negative, apheresis/pheresis, each unit    1017
C1018    Blood, leukoreduced, irradiated, each unit    1018
C1019    Platelet, leukoreduced, irradiated, apheresis/pheresis, each unit    1019
P9010    Blood (whole), for transfusion, per unit    0950
P9012    Cryoprecipitate, each unit    0952
P9013    Fibrinogen unit    0953
P9016    Leukocyte poor blood, each unit    0954
P9017    Plasma, single donor, fresh frozen, each unit    0955
P9018    Plasma protein fraction, each unit    0956
P9019    Platelet concentrate, each unit    0957
P9020    Platelet rich plasma, each unit    0958
P9021    Red blood cells, each unit    0959
P9022    Washed red blood cells, each unit    0960
P9023    Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit    0949

Blood/Blood Products Classified in Separate APCs (Effective October 1, 2000)

The following blood/blood products are classified in separate APCs. Since these are classified in separate APCs, they are not eligible for transitional pass-through payments.

HCPCS Code Long Description    APC
C9500    Platelets, irradiated, each unit    9500
C9501    Platelets, pheresis, each unit    9501
C9502    Platelets, pheresis, irradiated, each unit    9502
C9503    Fresh frozen plasma, donor retested, each unit    9503
C9504    Red blood cells, deglycerolized, each unit    9504
C9505    Red blood cells, irradiated, each unit    9505

CPT codes and descriptions only are copyright 2000 American Medical Association (or such other date publication of CPT)


2001 Empire Medicare Services
http://www.empiremedicare.com

http://www.empiremedicare.com/newsupda/2001-01/blood.htm

Issue 2001-01, January 2001



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