Blood Processing

Policy No: 110
Originally Created: 09/01/2015
Section: Medicine
Last Reviewed: 09/01/2018
Last Revised: 09/01/2018
Approved: 09/20/2018
Effective: 11/01/2018

The policy applies to inpatient and outpatient facilities.

Definitions

Blood Components

Whole Blood
Whole blood contains red cells, white cells, and platelets (~45% of volume) suspended in plasma (~55% of volume).

Red Cells
Red cells, or erythrocytes, carry oxygen from the lungs to the body's tissue and take carbon dioxide back to the lungs to be exhaled.

Platelets
Platelets, or thrombocytes, are small, colorless cell fragments in the blood whose main function is to interact with clotting proteins to stop or prevent bleeding.

Plasma
Plasma is a fluid, composed of about 92% water, 7% vital proteins such as albumin, gamma globulin, anti- hemophilic factor, and other clotting factors, and 1% mineral salts, sugars, fats, hormones and vitamins.

Cryoprecipitated Antihemophilic Factor (AHF)
Cryoprecipitated AHF (Cryo) is a portion of plasma rich in clotting factors, including Factor VIII and fibrinogen. It is prepared by freezing and then slowly thawing the frozen plasma.

Policy Statement

Payment for blood, blood products, and blood processing related services will be in accordance with the guidelines outlined in this reimbursement policy.

Inpatient Facility
Inpatient facilities bill for blood, blood product and blood product related services using Revenue Codes on the Uniform Billing (UB-04) form/format. Inpatient facilities do not use Current Procedural Technology (CPT®/HCPCS Level I) or Healthcare Common Procedure Coding System (HCPCS/HCPCS Level II) codes on the UB-04 form/format.

Inpatient facilities use the following Revenue Codes for Blood, Blood Products and Blood Processing:

  • 0381 - Packed red blood cells
  • 0382 - Whole blood
  • 0383 - Plasma
  • 0384 - Platelets
  • 0385 - Leukocytes
  • 0386 - Other Blood Components
  • 0387 - Other Derivative (Cryoprecipitates)
  • 0389 - Other Blood and Blood Components
  • 0391 - Blood Administration
  • 0390 - Blood Processing/Storage
  • 0392 - Blood Processing/Storage; Processing and Storage; or
  • 0399 - Blood Processing /Storage; Other Processing and Storage

  1. If an Inpatient facility furnishes blood or a blood product collected by its own blood bank for which only processing and storage costs are assessed, or when a facility procures blood or a blood product from a community blood bank (i.e. Puget Sound Blood Center) for which it is charged only the processing and storage costs incurred by the community blood bank, the facility can bill one of the following revenue codes for each unit transfused, and the line item date of service:
    • 0390 - Blood Processing/Storage
    • 0392 - Blood Processing/Storage; Processing and Storage; or
    • 0399 - Blood Processing /Storage; Other Processing and Storage
  2. Processing & Storage Costs - Inpatient processing and storage costs are considered as part of the 0390, 0392 and 0399 revenue code reimbursement and should not be billed separately:
    • Blood product collection
    • Safety testing
    • Retyping
    • Pooling
    • Irradiating
    • Leukocyte-reducing
    • Freezing
    • Thawing blood products
    • Cost of blood delivery
    • Cost of blood monitoring
    • Cost of blood storage
  3. If an inpatient facility pays for the actual blood or blood product itself, in addition to paying for processing and storage costs when blood or blood products are supplied by either a community blood bank or the facility's own blood bank, the facility provider must separate the charge for the unit(s) of blood or blood product(s) from the charge for processing and storage services. The facility may only charge one fee for processing and storage.
    • The facility should report charges for the blood or blood product itself using Revenue Code series 038X (i.e. 0381 – 0389). If the facility charges for processing and storage services, it may charge only one processing/storage fee regardless of how many processes were used to prepare the blood product and it must do so on a separate line using Revenue Code 0390, 0392, or 0399 with the line item date of service and the number of units transfused.
  4. Unused Blood - When blood or blood products which the facility has collected in its own blood bank or received from a community blood bank are not used, processing and storage costs incurred by the community blood bank and the facility cannot be charged to the member.

    • However, certain member-specific blood preparation costs incurred by the facility (e.g., blood typing and cross-matching; splitting or irradiation) can be charged to the member under Revenue Code Series 30X or 31X (Laboratory and Laboratory Pathological). Member-specific preparation charges should be billed on the dates the services were provided.
    • Where the unit of blood is split or irradiated and stored without specific intention to administer it to a member at the time of splitting or irradiation and is not subsequently transfused, there is no service to be reported.

Outpatient Facility
Outpatient facilities bill for blood, blood product and blood product related services using Revenue Codes in addition to using the appropriate CPT/HCPCS Level I or HCPCS/HCPCS Level II codes for the product or services on the Uniform Billing (UB-04/CMS-1450) form/format.

Outpatient facilities use the following Revenue Codes for Blood, Blood Products and Blood Processing:

  • 0381 - Packed red blood cells
  • 0382 - Whole blood
  • 0383 - Plasma
  • 0384 - Platelets
  • 0385 - Leukocytes
  • 0386 - Other Blood Components
  • 0387 - Other Derivative (Cryoprecipitates)
  • 0389 - Other Blood and Blood Components
  • 0391 - Blood Administration
  • 0390 - Blood Processing/Storage
  • 0392 - Blood Processing/Storage; Processing and Storage; or
  • 0399 - Blood Processing /Storage; Other Processing and Storage

  1. If an outpatient facility furnishes blood or a blood product collected by its own blood bank for which only processing and storage costs are assessed, or when a facility procures blood or a blood product from a community blood bank (i.e. Puget Sound Blood Center) for which it is charged only the processing and storage costs incurred by the community blood bank, the facility can bill one of the following revenue codes for each unit transfused along with the appropriate HCPCS codes for the service/product:

  • 0390 - Blood Processing/Storage
  • 0392 - Blood Processing/Storage; Processing and Storage; or
  • 0399 - Blood Processing /Storage; Other Processing and Storage

  1. Processing & Storage Costs - If the facility charges for processing and storage services, it may charge only one processing/storage fee regardless of how many processes were used to prepare the blood product and it must do so on a separate line using Revenue Code 0390, 0392, or 0399 with the line item date of service and the number of units transfused.

  • Blood product collection
  • Safety testing
  • Retyping
  • Pooling
  • Irradiating
  • Leukocyte-reducing
  • Freezing
  • Thawing blood products
  • Cost of blood delivery
  • Cost of blood monitoring
  • Cost of blood storage.
  • If an outpatient facility pays for the actual blood or blood product itself, in addition to paying for processing and storage costs when blood or blood products are supplied by a community blood bank or the facility's own blood bank, the facility may only charge one fee for processing and storage. The facility should report charges for the blood or blood product itself using Revenue Code series 038X with the line item date of service, the number of units transfused, and the appropriate blood product HCPCS code and HCPCS modifier "BL".
  • If the facility charges for processing and storage services, it may charge only one processing/storage fee regardless of how many processes were used to prepare the blood product and it must do so on a separate line using Revenue Code 0390, 0392, or 0399 with the line item date of service and the number of units transfused and the appropriate blood product HCPCS code and HCPCS modifier "BL".
  • The same line item date of service, the same number of units, the same HCPCS code, and HCPCS modifier BL must be reported on both lines. This requirement applies to all facilities that transfuse blood and incur charges for both the blood itself and processing and storage.

  1. Autologous Blood - In general, when autologous (pre-deposited or obtained through intra- or postoperative salvage) or directed-donor transfusion is performed, facilities should bill for the transfusion service and the number of units of the appropriate HCPCS code that describes the blood product.

  • Reimbursement for the product is intended to cover the costs associated with providing the autologous or directed donor blood product service (e.g., collection, processing, transportation and storage).
  • Facilities should bill the transfusion service and the blood product HCPCS code on the date that the transfusion took place and not on the date when the autologous blood was collected.
  • When an autologous blood product is collected but not transfused, facilities should bill CPT 86890 (autologous blood or component, collection, processing, and storage; pre-deposited) or 86891(autologous blood or component, collection, processing, and storage; intra- or postoperative salvage) and the number of units collected but not transfused. CPT 86890 and 86891 are intended to provide payment for the additional resources needed to provide these services, which are not captured when a blood product HCPCS code is not billed.
  • Because billing 86890 or 86891 is only indicated when autologous blood is collected but not transfused, the facility should bill 86890 or 86891 on the date when the facility is certain the blood will not be transfused (i.e., date of a procedure or date of member discharge), rather than on the date of the product's collection or receipt from the supplier.
  • When a directed donor blood product is collected but not transfused to the initial targeted recipient or to any other member, refer to the section titled "Unused Blood."

  1. Split Unit of Blood - HCPCS code P9011 was created to identify situations where one unit of blood or a blood product is split and some portion of the unit is transfused to one member and the other portions are transfused to other members or to the same member at other times.

  • When a member receives a transfusion of a split unit of blood or blood product, facilities should bill P9011 for the blood product transfused, as well as CPT 86985 (Splitting, blood products) for each splitting procedure performed to prepare the blood product for a specific member.
  • Facilities should bill split units of packed red cells and whole blood using Revenue Code 389 (Other blood), and should not use Revenue Codes 381 (Packed red cells) or 382 (Whole blood). Providers should bill split units of other blood products using the applicable revenue codes for the blood product type, such as 383 (Plasma) or 384 (Platelets), rather than 389.

  1. Irradiation of Blood Products - In situations where a member receives a medically reasonable and necessary transfusion of an irradiated blood product:

  • An outpatient facility may bill the specific HCPCS code which describes the irradiated product, if a specific code exists, in addition to the CPT code for the transfusion.
  • If a specific HCPCS code for the irradiated blood product does not exist, then the facility should bill the appropriate HCPCS code for the blood product, along with CPT code 86945 (irradiation of blood product, each unit).

  1. Frozen and Thawed Blood and Blood Products

  • In situations where a member receives a transfusion of frozen blood or a blood product which has been frozen and thawed for the member prior to the transfusion, an outpatient facility may bill the specific HCPCS code which describes the frozen and thawed product, if a specific code exists, in addition to the CPT code for the transfusion.
  • If a specific HCPCS code for the frozen and thawed blood or blood product does not exist, then the facility should bill the appropriate HCPCS code for the blood product, along with CPT codes for freezing and/or thawing services that are not reflected in the blood product HCPCS code.
  • If a blood product has been frozen and/or thawed in preparation for a transfusion, but the member does not receive the transfusion of the blood product, the facility may bill the member for the CPT code that describes the freezing and/or thawing services specifically provided for the member. Similar to billing for autologous blood collection when blood is not transfused, the facility should bill the freezing and/or thawing services on the date when the facility is certain the blood product will not be transfused (e.g., date of a procedure or date of member discharge), rather than on the date of the freezing and/or thawing services.

The chart of blood and blood products, shown below, indicates whether outpatient facilities should bill separately for freezing and thawing based on HCPCS codes. If this concept is not applicable, the code has been omitted from the chart (for example: P9043, P9048, P9050).

  1. Unused Blood - When blood or blood products which the facility has collected in its own blood bank or received from a community blood bank are not used, processing and storage costs incurred by the community blood bank and the facility cannot be charged to the member.

  • However, certain member-specific blood preparation costs incurred by the facility (e.g., blood typing and cross-matching) can be charged to the member under Revenue Code Series 30X or 31X (Laboratory and Laboratory Pathological). Member-specific preparation charges should be billed on the dates the services were provided.
  • Where blood or a blood product is split or irradiated specifically with the intent of transfusion to a member but is not then used, the outpatient hospital may bill for the services of splitting or irradiating the unit of blood, but may not bill for the HCPCS code for the blood product that was not transfused. The date of service must be the date on which the decision not to use the blood was made and indicated in the member's medical record.
  • Where the unit of blood is split or irradiated and stored without specific intention to administer it to a member at the time of splitting or irradiation and is not subsequently transfused, there is no service to be reported.

  1. Transfusion Services

  • To report charges for transfusion services, facilities should bill the appropriate CPT code for the specific transfusion service provided under Revenue Code 391 (Blood Administration).
  • Transfusion services codes are billed on a per service basis, and not by the number of units of blood product transfused. For payment, a blood product HCPCS code is required when billing a transfusion service code.
  • Blood Transfusions, with CPT codes 36430, 36440, 36450, and 36455 should be billed as one (1) per session, regardless of the number of units transfused on any given date of service.

  1. Pheresis and Apheresis Services

  • Apheresis/pheresis services are billed on a per visit basis and not on a per unit basis.
  • Facilities should report the charge for an Evaluation and Management (E&M) visit only if there is a separately identifiable E&M service performed which extends beyond the evaluation and management portion of a typical apheresis/pheresis service.
  • If the outpatient facility is billing an E&M visit code in addition to the apheresis/pheresis service, it may be appropriate to use the HCPCS modifier 25.

References

American Red Cross, Learn About Blood: Blood Components

Centers for Medicare & Medicaid Services (CMS), Medicare Benefit Policy Manual, Chapter 17 – Drugs and Biologicals

Centers for Medicare & Medicaid Services (CMS), Medicare Benefit Policy Manual, Chapter 4 – Part B Hospitals (Including Inpatient Hospital Part B and OPPS)

Cross References

None

Blood and blood products
HCPCSDescriptionBilling/Reimbursement of Freezing/Thawing Allowed?
P9010Blood (whole), for transfusion, per unitFreezing & Thawing are separately reimbursable
P9011Blood, split unitFreezing & Thawing are separately reimbursable
P9012Cryoprecipitate, each unitFreezing & Thawing codes are not separately reimbursable
P9016Red blood cells, leukocytes reduced, each unitAlternative P-code for frozen/ thawed product available
P9017Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unitFreezing & Thawing codes are not separately reimbursable
P9019Platelets, each unitFreezing & Thawing are separately reimbursable
P9020Platelet rich plasma, each unitFreezing & Thawing are separately reimbursable
P9021Red blood cells, each unitFreezing & Thawing are separately reimbursable
P9022Red blood cells, washed, each unitFreezing & Thawing are separately reimbursable
P9023Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unitFreezing & Thawing codes are not separately reimbursable
P9031Platelets, leukocytes reduced, each unitFreezing & Thawing are separately reimbursable
P9032Platelets, irradiated, each unitFreezing & Thawing are separately reimbursable
P9033Platelets, leukocytes reduced, irradiated, each unitFreezing & Thawing are separately reimbursable
P9034Platelets, pheresis, each unitFreezing & Thawing are separately reimbursable
P9035Platelets, pheresis, leukocytes reduced, each unitFreezing & Thawing are separately reimbursable
P9036Platelets, pheresis, irradiated, each unitFreezing & Thawing are separately reimbursable
P9037Platelets, pheresis, leukocytes reduced, irradiated, each unitFreezing & Thawing are separately reimbursable
P9038Red blood cells, irradiated, each unitFreezing & Thawing are separately reimbursable
P9039Red blood cells, deglycerolized, each unitFreezing & Thawing codes are not separately reimbursable
P9040Red blood cells, leukocytes reduced, irradiated, each unitFreezing & Thawing are separately reimbursable
P9044Plasma, cryoprecipitate reduced, each unitFreezing & Thawing codes are not separately reimbursable
P9051Whole blood or red blood cells, leukocytes reduced, cmv-negative, each unitFreezing & Thawing are separately reimbursable
P9052Platelets, HLA-matched leukocytes reduced, apheresis/pheresis, each unitFreezing & Thawing are separately reimbursable
P9053Platelets, pheresis, leukocytes reduced, cmv-negative, irradiated, each unitFreezing & Thawing are separately reimbursable
P9054Whole blood or red blood cells, leukocytes reduced, frozen, deglycerol, washed, each unitFreezing & Thawing codes are not separately reimbursable
P9055Platelets, leukocytes reduced, cmv-negative, apheresis/pheresis, each unitFreezing & Thawing are separately reimbursable
P9056Whole blood, leukocytes reduced, irradiated, each unitFreezing & Thawing are separately reimbursable
P9057Red blood cells, frozen/deglycerolized/ washed, leukocytes reduced, irradiated, each unitFreezing & Thawing codes are not separately reimbursable
P9058Red blood cells, leukocytes reduced, cmv-negative, irradiated, each unitFreezing & Thawing are separately reimbursable
P9059Fresh frozen plasma between 8-24 hours of collection, each unitFreezing & Thawing codes are not separately reimbursable
P9060Fresh frozen plasma, donor retested, each unitFreezing & Thawing codes are not separately reimbursable

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.