(Medicare Claims Processing Manual)

When a directed donor blood product is collected but not transfused to the initial targeted recipient or to any other patient, refer to the section 231.7 titled Billing for Unused Blood.   231.4 - Billing for Split Unit of Blood  (Rev. 1487, Issued: 04- 08-08, Effective: 04 -01-08, Implementation: 04- 07-08)  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 patient and the other portions are transfused to other patients or to the same patient at other times.   When a patient receives a transfusion of a split unit of blood or blood product, OPPS providers 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 patient.   Providers 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.  Reporting revenue codes according to these specifications will ensure the Medicare beneficiary's blood deductible is applied correctly.  EXAMPLE:   OPPS provider splits off a 100cc aliquot from a 250 cc unit of leukocyte -reduced red blood cells for a transfusion to Patient X.  The hospital then splits off an 80cc aliquot of the remaining unit for a transfusion to Patient Y. At a later time, the rema ining 70cc from the unit is transfused to Patient Z.  In billing for the services for Patient X and Patient Y, the OPPS provider should report the charges by billing P9011 and 86985 in addition to the CPT code for the transfusion service, because a specific splitting service was required to prepare a split un it for transfusion to each of those patients. However, the OPPS provider should report only P9011 and the CPT code for the transfusion service for Patient Z because no additional splitting was necessary to prepare the split unit for transfusion to Patient Z.  The OPPS provider should bill Revenue Code 0389 for each split unit of the leukocyte -reduced red blood cells that was transfused.   231.5 - Billing for Irradiation of Blood Products  (Rev. 496, Issued: 03- 04-05, Effective: 07 -01-05, Implementation: 07- 05-05)  In situations where a beneficiary receives a medically reasonable and necessary transfusion of an irradiated blood product, an OPPS provider 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 OPPS provider should bill the appropriate HCPCS code for the blood product, along with CPT code 86945 (irradiation of blood product, each unit).  EXAMPLE:   If an OPPS provider transfuses the product described by P9040 (red blood cells, leukocytes reduced, irradiated, each unit), it would not be appropriate to bill an additional CPT code for irradiation of the blood product since charges for irradiation should be included in the charge for P9040.   231.6 - Billing for Frozen and Thawed Blood and Blood Products  (Rev. 1487, Issued: 04- 08-08, Effective: 04 -01-08, Implementation: 04- 07-08)  In situations where a beneficiary receives a transfusion of frozen blood or a blood product which has been frozen and thawed for the patient prior to the transfusion, an OPPS provider 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 OPPS provider 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.  EXAMPLE:  If an OPPS provider transfuses the product described by P9057 (red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit), it would not be appropriate to bill additional CPT codes for freezing and/or thawing since charges for freezing and thawing should be included in the charge for P9057.   If a blood product has been frozen and/or thawed in preparation for a transfusion, but the patient does not receive the transfusion of the blood product, the OPPS provider may bill the patient for the CPT code that describes the freezing and/or thawing ser vices specifically provided for the patient.  Similar to billing for autologous blood collection when blood is not transfused, the OPPS provider should bill the freezing and/or thawing services on the date when the OPPS provider is certain the blood produc t will not be transfused (e.g., date of a procedure or date of outpatient discharge), rather than on the date of the freezing and/or thawing services.   The following chart of blood and blood products indicates whether providers should bill separately for freezing and thawing using the available CPT codes.   HCPCS/CPT  Short Descriptor  Billing of Freezing/Thawing  P9010  Whole blood for transfusion  Freezing and thawing are separately billable  P9011  Blood split unit  Freezing and thawing are separately billable  P9012  Cryoprecipitate each unit  Freezing and thawing codes not separately billable  P9016  RBC leukocytes reduced  Alternative P -code for frozen/thawed product available  P9017  Plasma 1 donor frz w/in 8 hr  Freezing and thawing codes not separately billable  P9019  Platelets, each unit  Freezing and thawing are separately billable  P9020  Plaelet rich plasma unit  Freezing and thawing are separately billable  P9021  Red blood cells unit  Alternative P -code for frozen/thawed product available  P9022  Washed red blood cells unit  Freezing and thawing are separately billable  P9023  Frozen plasma, pooled, sd  Freezing and thawing codes not separately billable  P9031  Platelets leukocytes reduced  Freezing and thawing are separately billable  P9032  Platelets, irradiated  Freezing and thawing are separately billable  P9033  Platelets leukoreduced irrad  Freezing and thawing are separately billable  P9034  Platelets, pheresis  Freezing and thawing are separately billable  P9035  Platelet pheres leukoreduced  Freezing and thawing are separately billable  P9036  Platelet pheresis irradiated  Freezing and thawing are separately billable  P9037  Plate pheres leukoredu irrad  Freezing and thawing are separately billable  P9038  RBC irradiated  Freezing and thawing are separately billable  P9039  RBC deglycerolized  Freezing and thawing codes not separately billable   P9040  RBC leukoreduced irradiated  Alternative P -code for frozen/thawed product available  P9043  Plasma protein fract,5%,50ml  Concept not applicable  P9044  Cryoprecipitate reduced plasma  Freezing and thawing codes not separately billable   P9048  Plasmaprotein fract,5%,250ml  Concept not applicable  P9050  Granulocytes, pheresis unit  Concept not applicable  P9051  Blood, l/r, cmv -neg Freezing and thawing are separately billable  P9052  Platelets, hla -m, l/r, unit  Freezing and thawing are separately billable  P9053  Plt, pher, l/r cmv -neg, irr  Freezing and thawing are separately billable  P9054  Blood, l/r, froz/degly/wash  Freezing and thawing codes not separately billable  P9055  Plt, aph/pher, l/r, cmv -neg Freezing and thawing are separately billable  P9056  Blood, l/r, irradiated  Freezing and thawing are separately billable  P9057  RBC, frz/deg/wsh, l/r, irrad  Freezing and thawing codes not separately billable  P9058  RBC, l/r, cmv -neg, irrad  Freezing and thawing are separately billable  P9059  Plasma, frz between 8 -24hour  Freezing and thawing codes not separately billable  HCPCS/CPT  Short Descriptor  Billing of Freezing/Thawing  P9060  Fr frz plasma donor retested  Freezing and thawing codes not separately billable   231.7 - Billing for Unused Blood  (Rev. 1487, Issued: 04- 08-08, Effective: 04 -01-08, Implementation: 04- 07-08)  When blood or blood products which the OPPS provider 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 OPPS provider cannot be charged to the beneficiary.  However, certai n patient -specific blood preparation costs incurred by the OPPS provider (e.g., blood typing and cross -matching) can be charged to the beneficiary under Revenue Code Series 30X or 31X.  Patient -specific preparation charges should be billed on the dates the  services were provided.   Processing and storage costs for unused blood products should be reported as costs under cost centers for blood on the OPPS providers Medicare Cost Report.  These are costs that are not considered patient -specific blood preparation services.  Costs for unused blood products which have been purchased also should be reported as costs under cost centers for blood on the Medicare Cost Report.  Where blood or a blood product is split or irradiated specifically with the intent of transfusion to a beneficiary but is not then used, the 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 patient's medical record.  Where the unit of blood is split or irradiated and stored without specific intention to administer it to a Medicare beneficiary at the time of splitting or irradiation and is not subsequently transfused, there is no service to be reported.   231.8 - Billing for Transfusion Services  (Rev. 496, Issued: 03- 04-05, Effective: 07 -01-05, Implementation: 07- 05-05)  To report charges for transfusion services, OPPS providers 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.  A transfusion APC will be paid to the OPPS provider for transfusing blood products once per day, regardle ss of the number of units or different types of blood products transfused.   231.9 - Billing for Pheresis and Apheresis Services  (Rev. 496, Issued: 03- 04-05, Effective: 07 -01-05, Implementation: 07- 05-05)  Apheresis/pheresis services are billed on a per visit basis and not on a per unit basis.  OPPS providers 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 OPPS provider is billing an E&M visit code in addition to the apheresis/pheresis service, it may be appropriate to use the HCPCS modifier - 25.  231.10 - Billing for Autologous Stem Cell Transplants  (Rev. 3556, Issued: 07- 01-2016; Effective: 01- 27-16; Implementation: 10 -03-16)  The hospital bills and shows all charges for autologous stem cell harvesting, processing, and transplant procedures based on the status of the patient (i.e., inpatient or outpatient) when the services are furnished.  It shows charges for the actual transplant, described by the appropriate ICD procedure or CPT codes in Revenue Center 0362 (Operating Room Services; Organ Transplant, Other than Kidney) or another appropriate cost  center.