evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
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 from 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
(Medicare Claims Processing Manual)
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 further 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 b lood cells.
(Medicare Claims Processing Manual)
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 transfused, 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, tra nsportation, 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.
(Medicare Claims Processing Manual)
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 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 billi ng 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 out patient 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 spl it 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.
(Medicare Claims Processing Manual)
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 remaining 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 unit 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 OPP S 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 C PT 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) .
(Medicare Claims Processing Manual)
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 servic es 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 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.
(Medicare Claims Processing Manual)
The following chart of blood and blood products indicates whether providers should bill separately for freezing and thawing using the available CPT codes.
(Medicare Claims Processing Manual)
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,
(Medicare Claims Processing Manual)
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
(Medicare Claims Processing Manual)
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)
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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).  The transplant hospital keeps an itemized statement that identifies the services furnished, the charges, the person receiving the service (donor/recipient), and whether this is  a potential transplant donor or recipient.  These charges will be reflected in the transplant hospital's stem cell/bone marrow acquisition cost center.  For allogeneic stem cell acquisition services in cases that do not result in transplant, due to death of the intended recipient or other causes, hospitals include the costs associated with the acquisition services on the Medicare cost  report.
(Medicare Claims Processing Manual)
In the case of an allogeneic transplant in the hospital outpatient setting, the hospital reports the transplant itself with the appropriate CPT code, and a charge under revenue center code 0362 or another appropriate cost center. Selection of the cost center is up to the hospital.  231.12 - Correct Coding Initiative (CCI) Edits (Rev. 1882, Issued:  12- 21-09; Effective Date:  01 -01-10; Implementation Date:  01 -04-10)  The OPPS providers should be aware that certain CCI edits may apply when billing for blood and blood product services.  The OPPS providers should consult the most current list of CCI edits to dete rmine whether they apply to the services or HCPCS blood product codes being reported.  A file with the most current list of CCI edits applicable to Medicare Part B services paid by A/B MACs (A) under the OPPS is available at:  http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp   240 - Inpatient Part B Hospital Services  (Rev. 3106, Issued: 11- 06-14, Effective: 10- 01-13, Implementation: 02- 10-15)   Medicare pays for hospital (including CAH) inpatient Part B services in the circumstances provided in Pub. 100- 02, Medicare Benefit Policy Manual, Chapter 6,  10 (Medical and Other Health Services Furnished to Inpatients of Participating Hospitals).  Hospitals must bill Part B inpatient services on a 12x Type of Bill.  This Part B inpatient  claim is subject to the statutory time limit for filing Part B claims described in chapter 1, 70 of this manual.    Inpatient Part B services include inpatient ancillary serv ices that do not require an outpatient status and are not strictly provided in an outpatient setting.  Services that require an outpatient status and are provided only in an outpatient setting are not payable inpatient Part B services, including Clinic Vis its, Emergency Department Visits, and Observation Services (this is not a complete listing).