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: reimburse@usa.redcross.org.

Is there a guide to the available codes for blood, blood products and plasma derivatives?

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?

The Medicare program exempts whole blood and red blood cells supplied by the Red Cross from the Medicare blood deductible. This is because the blood and blood products that the Red Cross supplies hospitals only carry a processing cost and no charge for the supply of the blood product itself. For documentation of this exemption, see the attached citation from the Code of Federal Regulations [Title 42, Section 409.87 (42 CFR § 409.87 -- Blood deductible)].

What is the difference between the following two revenue code series: 038x (blood) and 039x (Blood and Blood Component Administration, Processing and Storage)?

Revenue code series 038x typically is used for blood and blood products carrying a charge for the products while revenue code series 039x is typically used for blood and blood products from a blood supplier that assesses only a per-unit processing cost but does not charge for the products.

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?

No. It is a hospital's responsibility to determine the appropriate charges for all of the services that it provides, including blood and blood components. The Red Cross has no policies or provisions in its Customer Agreements or contracts that would require a provider to charge in any particular manner.

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.