CMS Pub. 100-04, ch. 4, § 231

and Related Services Under the Hospital Outpatient Prospective

Payment System (OPPS)

(Rev. 1702, Issued: 03-13-09, Effective: 04-01-09, Implementation: 04-06-09)

231.1 - When a Provider Paid Under the OPPS Does Not Purchase the

Blood or Blood Products That It Procures from a Community Blood

Bank, or When a Provider Paid Under the OPPS Does Not Assess a

Charge for Blood or Blood Products Supplied by the Provider’s Own

Blood Bank Other Than Blood Processing and Storage

(Rev. 1702, Issued: 03-13-09, Effective: 04-01-09, Implementation: 04-06-09)

When an OPPS provider furnishes blood or a blood product collected by its own blood

bank for which only processing and storage costs are assessed, or when an OPPS

provider procures blood or a blood product from a community blood bank for which it is

charged only the processing and storage costs incurred by the community blood bank, the

OPPS provider bills the processing and storage charges using Revenue Code 0390 (Blood

Processing/Storage), 0392 (Blood Processing/Storage; Processing and Storage), or 0399

(Blood Processing /Storage; Other Processing and Storage), along with the appropriate

blood HCPCS code, the number of units transfused, and the line item date of service

(LIDOS). Processing and storage costs may include blood product collection, safety

testing, retyping, pooling, irradiating, leukocyte-reducing, freezing, and thawing blood

products, along with the costs of blood delivery, monitoring, and storage. In general,

such categories of processing costs are not patient-specific. There are specific blood

HCPCS codes for blood products that have been processed in varying ways, and these

codes are intended to make payment for the variable resource costs of blood products that

have been processed differently.

Most OPPS providers obtain blood or blood products from community blood banks that

charge only for processing and storage, and not for the blood itself. These hospitals

should follow the instructions outlined in this section. Those OPPS providers that incur a

charge for the blood product itself, in addition to the charge for processing and storage,

should follow the coding requirements outlined in §231.2.

231.2 - When a Provider Paid Under the OPPS Purchases Blood or

Blood Products from a Community Blood Bank or When a Provider

Paid Under the OPPS Assesses a Charge for Blood or Blood Products

Collected By Its Own Blood Bank That Reflects More Than Blood

Processing and Storage

(Rev. 1702, Issued: 03-13-09, Effective: 04-01-09, Implementation: 04-06-09)

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 provider’s own blood bank, the OPPS

provider 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 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 bank’s 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 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 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.