FAQs about Coding, Coverage and Reimbursement
Please see the answers to some commonly asked questions regarding coding, coverage and reimbursement below. If you have questions that are not answered here, please contact us at: email@example.com.
The Medicare program has a blood deductible provision that requires that Medicare beneficiaries pay out of pocket or replace the first three units of whole blood or packed red blood cells that they use in a calendar year. How does this provision affect blood supplied by the Red Cross?
What is the difference between the following two revenue code series: 038x (blood) and 039x (Blood and Blood Component Administration, Processing and Storage)?
Hospitals traditionally have billed for blood and blood products under revenue code 0390 for most payers when the products are supplied by a non-profit blood supplier, such as the Red Cross. This is generally used when the charge reflects a processing cost but not a charge for the blood itself. Some payers alternatively may require use of revenue code 0391 (Administration). Revenue code series 038x would still be used for blood and blood products carrying a charge.
For more information on this topic, please see our coding resources.
Does the Red Cross have any restrictions on what a hospital or other provider may charge a payer or patient for a unit of blood or blood product?
If hospitals have specific charging questions, it is advised that hospitals contact their legal and compliance advisors. Healthcare providers should make the ultimate determination as to when to use a specific product based on clinical appropriateness. In addition, providers must determine the most appropriate and proper way in which to code and bill for all products and services that they provide to patients.