CMS Pub. 100-04, ch. 17, § 80.4

Blood clotting factors not paid on a cost or prospective payment system basis are priced

as a drug/biological under the drug pricing fee schedule effective for the specific date of

service. As of January 1, 2005, the average sales price (ASP) plus 6 percent shall be

used.

If a beneficiary is in a covered part A stay in a PPS hospital, the clotting factors are paid

in addition to the DRG/HIPPS payment. For FY 2005, this payment is based on 95

percent of AWP. For FY 2006, the add-on payment for blood clotting factor

administered to hemophilia inpatients is based on average sales price (ASP) + 6 percent

and a furnishing fee. The furnishing fee is updated each calendar year. For a SNF

subject to SNF/PPS, the payment is bundled into the SNF/PPS rate.

For hospitals subject to OPPS, the clotting factors, when paid under Part B, are paid the

APC. For SNFs the clotting factors, when paid under Part B, are paid based on cost.

A/B MACs (B) shall process non-institutional blood clotting factor claims.

The A/B MACs (A) shall process institutional blood clotting factor claims (Part A and

Part B institutional).