A: In the context of blood reimbursement, HCPCS (Healthcare Common Procedure Coding System) codes are “P-codes” that describe different types of blood products (e.g., RBCs, platelets), while CPT (Current Procedural Terminology) codes describe various types of procedures and services, including transfusions and blood bank laboratory tests/services (like crossmatching and antigen screening).

Note: An exception is HCPCS code P9100 (Pathogen[s] test for platelets), which is a testing code and not a product code.

A: PAS platelets have the same HCPCS codes as the corresponding ‘regular’ (i.e., full plasma-containing) platelets. For example, leukoreduced apheresis PAS platelets would be reported with HCPCS code P9035 (Platelets, pheresis, leukocytes reduced, each unit).

A: No. HCPCS and CPT codes are generally not used on hospital inpatient claims; instead, hospitals typically report inpatient charges using only revenue codes.   Note:  An exception is hemophilia clotting factors, for which Medicare accepts HCPCS codes on inpatient claims in certain circumstances.

A: If a specific CPT is not available for a blood bank laboratory service, hospitals should not bill separately for the service. Instead, hospitals can incorporate the cost of the laboratory service into their processing charges for the blood units, which would be billed under:

• Revenue code 0390 in the hospital inpatient setting, or
• Revenue code 0390 + P‐code in the hospital outpatient setting

A: There is no plasma P-code that includes “liquid” in the descriptor; therefore, hospitals would need to review the available P-codes for plasma (those that apply to Red Crossprovided products are listed below) and select the code that most closely describes the product being transfused. Because there is not an exact match, each hospital must make its own determination as to which code is most appropriate.

P9017: Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit

P9044: Plasma, cryoprecipitate reduced, each unit

P9059: Fresh frozen plasma between 8-24 hours of collection, each unit

P9060: Fresh frozen plasma, donor retested, each unit

Note: The above list does not include P-codes for plasma products that are not offered by the Red Cross.

A: The CPT code is 86902 - Blood typing; antigen testing of donor blood using reagent serum, each antigen test. Providers should bill for CPT code 86902 based on the number of antigens times the number of blood units screened.

A:  When irradiated units are transfused in the hospital outpatient setting, hospitals should use an irradiated P-code if available. It is not appropriate to bill irradiation CPT code 86945 (Irradiation of blood product, each unit) in addition to an irradiated P-code.

However, hospitals may report CPT code 86945 in conjunction with a non-irradiated P-code if an appropriate irradiated P-code is not available.

This guidance does not differentiate between irradiating units inhouse vs. obtaining irradiated units from the blood supplier.

In the hospital outpatient setting, if an irradiated unit is intended for a specific patient but is not transfused, hospitals may bill for the irradiation using CPT code 86945 (but may not bill for the blood product or the transfusion procedure).

A: There are four HCPCS P-codes that describe CMV-negative blood products:

• P9051, Whole blood or red blood cells, leukocytes reduced, CMV-negative, each unit
• P9053, Platelets, pheresis, leukocytes reduced, CMVnegative, irradiated, each unit
• P9055, Platelets, leukocytes reduced, CMV-negative, apheresis/pheresis, each unit
• P9058, Red blood cells, leukocytes reduced, CMV-negative, irradiated, each unit

A: The only HCPCS P-codes that describe pooled blood products are for plasma:

• P9023 – Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit
• P9070 – Plasma, pooled multiple donor, pathogen reduced, frozen, each unit.

For other types of pooled blood products (such as platelets and cryoprecipitate), hospitals have the option of charging:

• one unit of CPT code 86965 (Pooling of platelets or other blood products) for the pooling, and
• the appropriate number of units of the applicable P-code for the blood unit.

For example, if a hospital uses a pooled product that includes five units of cryoprecipitate, the facility could bill:

• one unit of pooling CPT code 86965, and
• five units of HCPCS code P9012 (Cryoprecipitate, each unit).

A: Leukoreduced RBCs are described by HCPCS code P9016 (Red blood cells, leukocytes reduced, each unit). There is no HCPCS Pcode for RBCs that says both "washed" and "leukoreduced," and it is not possible to bill separately for washing. An alternative option would be to use P9022 (RBCs, washed, each unit) instead of P9016; however, P9016 is the more commonly used code.

A: Yes. The units of service for CPT code 86902 (Blood typing; antigen testing of donor blood      using reagent serum, each antigen test) should be determined by multiplying the number of antigens by the number of blood units screened (not the number of blood units transfused). Therefore, it is appropriate to report CPT code 86902 for all blood units screened, regardless of whether the units end up being transfused to the patient.

A:  In the hospital outpatient setting, providers can bill for LVDStested platelets by reporting:

• The platelet P-code that would otherwise apply, and HCPCS code P9100 (Pathogen test[s] for platelets) for the LVDS testing

For example, LVDS-tested leukocyte-reduced apheresis platelets could be reported with the following codes: P9035 (Platelets, pheresis, leukocytes reduced, each unit) + P9100.

Note: HCPCS code P9100 is a testing code and not a product code.

A: HLA-matched platelets are described by HCPCS code P9052 - Platelets, HLA-matched leukocytes reduced, apheresis/pheresis, each unit

Note: There is no separate CPT code for HLA matching.

A: The CPT code for leukapheresis is 36511 - Therapeutic apheresis; for white blood cells.

A: The CPT code for thrombocytapheresis is 36513 – Therapeutic apheresis; for platelets.

A: No. Hospitals may never bill Medicare for unused blood units. This means that hospitals may not submit charges for units that are ordered but not transfused.

A: Medicare and other payers generally do not allow hospitals to bill separately for additional testing that is confirmatory in nature. Therefore, if a test is repeated solely to confirm the results of a previous test, then only one of the tests can be billed. It would not be appropriate to bill for the second round of testing, even if it is a regulatory requirement. Hospitals could include the cost of the second test in their charge for the blood unit (revenue code 0390 + blood product P-code in the hospital outpatient setting), but this would not result in additional reimbursement.

A:  In general, hospitals may bill Medicare for medically necessary patient-specific laboratory services performed on blood units (e.g., crossmatching), even when such services are performed by the blood supplier.

This practice is known as providing services “under arrangements.” Information on Medicare’s requirements for services to be covered under arrangements can be found in Section 10.3 of Chapter 5 of the Medicare General Information, Eligibility, and Entitlement Manual: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/ge101c05.pdf

A: MUE stands for Medically Unlikely Edit. MUEs are a type of coding edit published by CMS’s National Correct Coding Initiative (NCCI). An MUE specifies the maximum number of billing units that Medicare will allow for an individual CPT or HCPCS code. If a provider bills for more units of a code than the value specified by the MUE for the same beneficiary on the same date of service, then all units of the code will be denied.

A: A list of publicly available MUEs can be downloaded from the NCCI website. https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits Hospitals should use the file titled “Facility Outpatient Hospital Services MUE Table.” The list of MUEs is updated quarterly.

Although most MUE values are published on the CMS website, some MUEs are kept confidential. Not all codes are subject to MUEs.

A: No; MUEs are specific to CPT and HCPCS codes, which are generally reported only on hospital outpatient claims.

A: In most cases, no; the majority of MUEs are “date of service” MUEs, which means that the MUE value applies even if a code is billed on multiple line items with a modifier. For many codes, Medicare contractors will consider appeals of MUE-related denials on a case-by-case basis.

A: PTP edits are another type of coding edit published by NCCI. Whereas MUEs specify the maximum allowed number of billing units for an individual CPT or HCPCS code, PTP edits identify combinations of codes that should not be reported together.

A: PTP edits are a type of coding edit published by NCCI. PTP edits identify combinations of CPT or HCPCS codes that should not be billed together. If a provider reports both codes of a PTP edit pair for the same beneficiary on the same date of service, then generally only one of the codes will be paid.

A: For some PTP edits, CMS may allow providers to report both codes together in limited circumstances when an appropriate modifier is used to indicate that the services are clinically justified; these edits have a Correct Coding Modifier Indicator (CCMI) of 1 (modifier allowed). For other PTP edits, a modifier may not be allowed because the codes should never be reported together for the same beneficiary on the same date of service; these edits have a CCMI of “0”  (modifier not allowed). A detailed discussion of the proper use of modifiers in the context of PTP edits is available at: https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-xu.pdf

A: A list of publicly available PTP edits can be downloaded from the NCCI website: https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits. Hospitals should use the file titled “Hospital PTP Edits.” The list of PTP edits is updated quarterly. Not all codes are subject to PTP edits.

A: Longstanding PTP edits prevent certain non-irradiated blood products from being paid separately when billed with irradiated blood products. In most cases, if an irradiated blood product P-code is billed together with a non-irradiated P-code for the same beneficiary on the same date of service, then only the irradiated Pcode would be paid. These irradiated/non-irradiated PTP edits apply even if the units are different types of blood products (e.g., RBCs and platelets). All of the irradiated/non-irradiated PTP edits have a CCMI of “1,” which means that a modifier is allowed. However, the use of a modifier would be inappropriate if an irradiated unit is provided solely for blood availability/inventory reasons.

A: In such a scenario, the hospital could avoid the PTP edit by “downcoding” the irradiated unit (i.e., using the corresponding nonirradiated P-code). For example, if a patient receives both an irradiated and non-irradiated leukoreduced RBC, the hospital could bill for both units using P9016 (RBCs, leukoreduced) instead of P9016 + P9040 (RBCs, leukoreduced, irradiated).

A: No. PTP edits are specific to CPT and HCPCS codes, which are generally reported only on hospital outpatient claims.

A: MUEs are another type of coding edit published by NCCI. Whereas PTP edits identify combinations of codes that should not be reported together, MUEs specify the maximum allowed number of billing units for an individual CPT or HCPCS code.

A: In the hospital outpatient setting, it would be appropriate to bill the following CPT codes if all three phases of crossmatching are performed:

• 86920 – Compatibility test each unit, immediate spin technique
• 86921 – Compatibility test each unit, incubation technique
• 86922 – Compatibility test each unit, antiglobulin technique

Although there also is a CPT code for electronic crossmatching (86923 – Compatibility test each unit, electronic), current PTP edits prevent this code from being paid separately when billed with any of the three crossmatching codes listed above.

A: There is no HCPCS P-code that specifically describes directed donor blood products, and the directed donor fee is not separately billable. If directed donor units are transfused, hospitals should bill for the units using whichever P-code would normally apply if the units were not directed donor. If a directed donor unit is not transfused, it would not be appropriate to bill for the blood product Pcode or the transfusion CPT code (since hospitals are never allowed to bill for unused blood), and there is no CPT code that can be used to bill for the additional costs and resources associated with directed donor blood.

A: Our most current reimbursement resources can be found on our website or SUCCESS® Platform.

• Hospital Partner Resource Guide (HPRG)
• SUCCESS® Reimbursement Training Modules

Note: If you don’t find what you need, please send an email to reimburse@redcross.org. In most cases, you can expect a response within 2 business days.