CMS Pub. 100-01, ch. 3, § 20.5.4.1

For replacement purposes, a pint of whole blood is considered equivalent to a unit of

packed red cells. A deductible pint of whole blood or unit of packed red cells is

considered replaced when a medically acceptable pint or unit is given or offered to the

provider or, at the provider's request, to its blood supplier. Accordingly, where an

individual or a blood bank offers blood as a replacement for a deductible pint or unit

furnished a Medicare beneficiary, the provider may not charge the beneficiary for the

blood, whether or not the provider or its blood supplier accepts the replacement offer.

Thus a provider may not charge a beneficiary merely because it is the policy of the

provider or its blood supplier not to accept blood from a particular source which has

offered to replace blood on behalf of the beneficiary. However, a provider would not be

barred from charging a beneficiary for deductible blood, if there is a reasonable basis for

believing that replacement blood offered by or on behalf of the beneficiary would

endanger the health of a recipient or that the prospective donor's health would be

endangered by making a blood donation. Once a provider accepts a pint of replacement

blood from a beneficiary or another individual acting on his/her behalf, the blood is

deemed to have been replaced, and, the beneficiary may not be charged for the blood,

even though the replacement blood is later found to be unfit and has to be discarded.

When a provider accepts blood donated in advance, in anticipation of need by a specific

beneficiary, whether the beneficiary's own blood, that is, an autologous donation, or

blood furnished by another individual or blood assurance group, such donations are

considered replacement for pints or units subsequently furnished the beneficiary.