(Medicare Claims Processing Manual)

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 bi ll 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 services specifically provided for the patient.  Similar to billing for autologous blood collection when blood is not trans fused, the OPPS provider should bill the freezing and/or thawing services on the date when the OPPS provider is certain the blood product 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 cod es 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    HCPCS/CPT  Short Descriptor  Billing of Freezing/Thawing  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  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.  Howeve r, certain 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 splittin g 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, regardless 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; Implemen tation: 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.   The CPT codes describing autologous stem cell harvest ing procedures may be billed and are separately payable under the Outpatient Prospective Payment System (OPPS) when provided in the hospital outpatient setting of care.  Autologous harvesting procedures are distinct from the acquisition services described in Pub. 100- 04, Chapter 3, 90.3.1 and 231.11 of this chapter for allogeneic stem cell transplants, which include services provided when stem cells are obtained from a donor and not from the patient undergoing the stem cell  transplant.   The CPT codes desc ribing autologous stem cell processing procedures also may be billed and are separately payable under the OPPS when provided to hospital  outpatients.   231.11 - Billing for Allogeneic Stem Cell Transplants  (Rev. 11150; Issued: 12- 10-21; Effective: 01- 01-22; Implementation: 01 -03-22)  1. Definition of Acquisition Charges for Allogeneic Stem Cell Transplants   Acquisition charges for allogeneic stem cell transplants include, but are not limited to, charges for the costs of the following services:   1. National Marrow Donor Program fees, if applicable, for stem cells from an unrelated  donor;   2. Tissue typing of donor and recipient;   3. Donor  evaluation;   4. Physician pre- procedure donor evaluation services;   5. Costs associated with harvesting procedure (e.g., general routine and special care services, procedure/operating room and other ancillary services, apheresis services,  etc.);   6. Post-operative/post -procedure evaluation of donor;  and  7. Preparation and processing of stem  cells.   Payment for these acquisition services is included in the OPPS C -APC  payment for  the allogeneic stem cell transplant when the transplant occurs in the hospital outpatient setting.  The Medicare contractor does not make separate payment for these acquisition services, because hospitals may bill and receive payment only for services provided to the Medicare beneficiary who is the recipient of the stem cell transplant and whose illness is being treated with the stem cell transplant.  Recurring update notifications describing changes to and billing instructions for various payment policies implemented in the OPPS are issued  annually.   Acquisition charges for stem cell transplants apply only to allogeneic transplants, for which stem cells are obtained from a donor (other than the recipient himself or herself).  Acquisition charges do not apply to autologous transplants (transplanted stem cells are obtained from the recipient himself or herself), because autologous transplants involve services provided to the beneficiary only (and not to a donor), for w hich the hospital may bill and receive payment (see Pub. 100- 04, chapter 3, 90.3.1 and 231.10 of this  chapter for information regarding billing for autologous stem cell  transplants).   2. Billing for Acquisition  Services   The hospital bills and shows acquisition charges for allogeneic stem cell transplants based on the status of the patient (i.e., inpatient or outpatient) when the transplant is  furnished.  See Pub. 100- 04, chapter 3, 90.3.1 for instructions regarding billing for acquisition services for a llogeneic stem cell transplants that are performed in the  inpatient setting.   Effective January 1, 2017, when the allogeneic stem cell transplant occurs in the outpatient setting, the hospital identifies stem cell acquisition charges for allogeneic bone marrow/stem cell transplants separately in FL 42 of Form CMS -1450 (or electronic equivalent) by using revenue code 0815 (Other Organ Acquisition).  Revenue code 0815 charges should include all services required to acquire stem cells from a donor, as defined above, and should be reported on the same claim as the transplant procedure in order to be appropriately packaged for payment  purposes.  Revenue code 0815 charges for allogeneic stem cell acquisition costs are reported on Worksheet D Part V, column 2, line  77, cost center 0077 of the hospital Medicare cost report (Form CMS -2552- 10).