| Unique Identifying Provider Number Ranges | 3rd - 6th digits: |
| Bill Types | - 011X - Inpatient
- 013X - Outpatient
- 014X - Hospital - laboratory to non-patient
- 018X - Hospital Swing Bed
- 021X - Skilled Nursing - inpatient
- 028X - Skilled Nursing - swing beds
- 071X - Rural Health Clinic (RHC)
- 072X - ESRD
- XX7 - Adjustment
- XX8 - Cancel
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Non-allowed Bill Type
CMS Internet Only Manual (IOM), Publication 101, Medicare General Information, Eligibility and Entitlement, Chapter 3, Section 20.5.2 | Blood and blood products cannot be billed on bill type 012X as inpatient Part B services. |
Billable Outpatient Blood Services
CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 231.1 - 231.8 | Medicare may not make payment on the first three (3) pints of whole blood or equivalent units of packed red blood cells given to a patient. Blood deductibles are charged for the cost of the blood product acquisition received under Part A and Part B combined in a calendar year.
Donor states have no charge associated with the acquisition of blood. The blood is donated by various people through blood banks such as the Red Cross. Since there is no charge associated with the acquisition of this blood, the blood deductible does not apply to blood given to a patient in these states. |
| Revenue Codes (RC) | Description: - 0381 - Red Blood Cells
- 0382 - Whole Blood
- 0383 - Plasma
- 0384 - Platelets
- 0385 - Leucocytes
- 0386 - Other Components
- 0387 - Other Derivatives (Cryopricipitates)
- 0389 - Other
- 0390 - General classification
- Use for incurred administrative cost from a community blood bank for processing, storage and related expenses
- 0391 - Transfusion - administration of blood
- Only one transfusion/administration may be billed per day regardless of how many pints given
- 0392 - Processing and storage
OPPS Hospitals - 030X Laboratory (hospitals can use to charge processing and administration or use RC 039X)
- 031X
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Non-allowed Revenue Codes
CMS Change Request (CR) 5867 | |
| Value Codes and Amount | - 06 - Medicare Blood Deductible
- Do not use this code if deductible pints have been replaced
- 37 - Units of Blood Furnished
- Total pints of whole blood or units of red cells = same units entered in RC 0381-0382
- 38 - Blood Deductible Units
- Patient responsible for first three (3) units. Do not use if blood is replaced or arrangements are made to replace. This field cannot be greater than 3
- 39 - Units of Blood Replaced
- Replaced red blood cells; at no charge or arrangements have been made
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HCPCS
CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 231.1 - 231.8 | Required for Hospital OPPS, line item date of service - Type and cross match
- Laboratory services
- Splitting procedure
- Use HCPCS P9011 for blood product transfused and HCPCS 88985 split blood products
- Irradiated products
- Use specific HCPCS code for irradiated product and CPT code for transfusion
- Frozen and thawed products
- Use specific HCPCS code that describes frozen and thawed product
- Unused frozen and thawed blood; bill date when OPPS provider is certain blood product will not be transfused
- Autologous blood product is collected, not transfused
- Use CPTs 86890 and 86891 to provide payment for additional resources
- Bill date when OPPS provider is certain product will not be transfused (do not use if transfused)
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Modifier
CMS IOM, Publication 100-4, Medicare Claims Processing Manual, Chapter 4, Section 231.2 | - BL- Special acquisition of blood and blood products
- Do not use when blood is received free (e.g., from a blood bank)
OPPS Hospital - BL modifier is appended HCPC on line item for blood and blood product and line item for processing and storage
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Blood Components Not Subject to Blood Deductible
CMS IOM, Publication 100-01, Medicare General Information, Eligibility and Entitlement, Chapter 3, Section 20.5.3 | - Blood components are covered as biologicals
- Platelets
- Fibrinogen
- Plasma
- Gamma Globulin
- Serum Albumin
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Donor State Blood Billing
Hospital OPPS and Critical Access Hospitals (CAH)
CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 231.1 - 231.8 | Value codes and amounts, BL modifier, and blood deductibles do not apply - Bill only charges under appropriate revenue code
- 030x/031x - Blood typing/cross-matching
- 0390 - Administrative cost (e.g., testing, storing, retyping, pooling, irradiating)
- 0391 - Administration of blood transfusions
- 0399 - Other Blood processing/storage
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Replaced Blood Billing
CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 231.1 - 231.8 | Provider may not charge for blood offered as a replacement for a deductible pint. Applies even if the offer is not accepted unless there is endangerment to recipient.
CAH - Bill value code and amount
- Bill appropriate RCs
- 038x - only if blood was not replaced
- 0390 - Administrative cost (e.g., testing, storing, retyping, pooling, irradiating)
If these RCs are applicable bill - 030x/031x - blood typing/cross-matching
- 0391 - Administration of blood transfusions
- 0399 - Other Blood processing/storage
- BL modifier not used
OPPS Hospital - Bill value code and amount
- Bill appropriate RCs
- 038x - Only if blood was not replaced
- 0390 - Administrative cost (e.g., testing, storing, retyping, pooling, irradiating)
If these RCs are applicable, bill - 030x/031x - Blood typing/cross-matching
- 0391 - Administration of blood transfusions
- 0399 - Other Blood processing/storage
- BL modifier is added to both line items
- HCPC for blood and blood product and
- HCPC for processing and storage
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Frequency of Billing
CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 50.2.2 | All services provided on the same day should be submitted on one claim or submitted monthly for repetitive services. See IOM for CMS defined - repetitive services |
| Beneficiary Coinsurance | - See annual benefits
- Clinical laboratory services are not subject to coinsurance. Non-clinical laboratory services are subject to coinsurance.
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Beneficiary Deductible
CMS, IOM, Publication 100-01, Medicare General Information, Eligibility and Entitlement, Chapter3, Section 20.5 | - Annual Part B deductible is 20% of covered charges
- Clinical laboratory services are not subject to deductible. Non-clinical laboratory services are subject to deductible.
- Plus, beneficiary is liable for payment of blood portion deductible
- Units of whole blood or packed red cells for which only processing and storage charges are reported are not subject to blood deductible
- Replaced blood is not subject to blood deductible
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