(Medicare Claims Processing Manual)

If an OPPS provider 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 OPPS providers own blood bank, the OPPS provide r must separate the charge for the unit(s) of blood or blood product(s) from the charge for processing and storage services.  The OPPS provider reports charges for the blood or blood product itself using Revenue Code series 038X (excluding 0380, which is not a valid revenue code for Medicare billing) with the LIDOS, the number of units transfused, and the appropriate blood product HCPCS code and HCPCS modifier BL.  The OPPS provider reports charges for processing and storage services on a separate line using Revenue Code 0390, 0392, or 0399 with the LIDOS, the number of units transfused, and the appropriate blood product HCPCS code and HCPCS modifier BL.  The same LIDOS, the same number of units, the same HCPCS code, and HCPCS modifier BL must be reported on both  lines.  This requirement applies to all OPPS providers that transfuse blood and incur charges for both the blood itself and processing and storage.   Effective for services furnished on or after July 1, 2005, the I/OCE will return to providers any claim that reports a charge for blood or blood products using Revenue Code 038X without a separate line for processing and storage services using Revenue Code  0390, 0392, or 0399.  Moreover, in order to process to payment, both lines must report the same line item date of service, the same number of units, and the same HCPCS code accompanied by modifier BL.  Payment for blood and blood products is based on the Ambulatory Payment Classification (APC) Group to which its HCPCS code is assigned, multiplied by the number of units transfused.  Units of whole blood or packed red cells for which only processing and storage charges are reported are not subject to the blood deductible.  The Medicare blood deductible is applicable only if the OPPS provider purchases whole blood or packed red cells fr om a community blood blank or if the OPPS provider assesses a charge that reflects more than blood processing and storage for whole blood or packed red cells collected by its owns blood bank.  If the beneficiary has not already fulfilled the annual blood deductible or replaced the blood, OPPS payment will be made for processing and storage costs only.  The beneficiary is liable for the blood portion of the payment as the blood deductible.  In order to ensure correct application of the Medicare blood deductible, providers should report charges for whole units of packed red cells using Revenue Code 381 (Packed red cells), and should report charges for whole units of whole blood using Revenue Code 382 (Whole blood).  Revenue Codes 381 and 382 should be used only to report charges for packed red cells and whole blood, respectively.   Please note that most hospitals obtain blood or blood products from community blood banks that charge only for processing and storage, rather than for the blood itself.  The blood coding requirements discussed in this section do not apply to blood and blood products carrying only a processing and storage fee; when billing only for blood processing and storage, OPPS providers should follow the coding requirements outlined in 231.1.  EXAMPLE:  An OPPS provider purchases 2 units of leukocyte -reduced red blood cells from a community blood bank and incurs a charge for the red cells themselves, and a charge for the blood banks processing and storage of the red blood cell unit.  The OPPS provider f urther incurs costs related to additional processing and storage of the red blood cell units after the OPPS provider has received the 2 units.  A Medicare beneficiary is transfused the two units of leukocyte -reduced red blood cells.  The OPPS provider should report the charges for 2 units of P9016 by separately billing the red blood cell charges and the total processing and storage charges incurred.  The charges for the red blood cell units are to be reported on one line with the date the blood was transfused, Revenue Code series 038X (excluding 380), 2 units, HCPCS code P9016, and modifier BL.  The total charges for processing and storage are to be reported on the same claim, on a separate line, showing the date the blood was transfuse d, Revenue Code 390, 0392, or 399, 2 units, HCPCS code P9016, and modifier BL.  Note that HCPCS modifier BL is reported on both lines.  231.3 - Billing for Autologous Blood (Including Salvaged Blood) and Directed Donor Blood  (Rev. 496, Issued: 03- 04-05, Effective: 07 -01-05, Implementation: 07- 05-05)  In general, when autologous (predeposited or obtained through intra - or postoperative salvage) or directed -donor transfusion is performed, OPPS providers should bill for the transfusion service and the number of units of the appropriate HCPCS code that describes the blood product.  Payment 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).  OPPS providers 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, OPPS providers should bill CPT 86890 (autologous blood or component, collection, processing, and storage; predeposited) or 86891(autologous blood or component, collection, processing, and st orage; 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 OPPS provider should bill 86890 or 86891 on the date when the OPPS provider is certain the blood will not be transfused (i.e., date of a procedure or date of outpatient discharge), rather than on the date of the products 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 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.