Ambulatory Payment Classifications

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Drugs and Biologicals (Excluding Cancer/Chemotherapy)

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Blood Products

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0961 Albumin (human),5%, 50ml
0963 Albumin (human), 5%, 250 ml
0964 Albumin (human), 25%, 20 ml
0965 Albumin (human), 25%, 50ml
9500 Platelets, irradiated
9501 Platelet pheres leukoreduced
9502 Platelet pheresis irradiated
9503 Fr frz plasma donor retested
9504 RBC deglycerolized
9505 RBC irradiated
9507 Platelets, pheresis
9508 Plasma 1 donor frz w/in 8 hr
9509 Frozen plasma, pooled, sd
9510 Whole blood for transfusion
9511 Cryoprecipitate each unit
9512 RBC leukocytes reduced
9513 Plasma, frz between 8-24hour
9514 Plasma protein fract,5%,50ml
9515 Platelets, each unit
9516 Plaelet rich plasma unit
9517 Red blood cells unit
9518 Washed red blood cells unit
9519 Plasmaprotein fract,5%,250ml
9520 Blood split unit
9521 Platelets leukoreduced irrad
9522 RBC leukoreduced irradiated
9523 Cryoprecipitatereducedplasma
9524 Blood, l/r, cmv-neg
9525 Platelets, hla-m, l/r, unit
9526 Platelets leukocytes reduced
9527 Blood, l/r, froz/degly/wash
9528 Plt, aph/pher, l/r, cmv-neg
9529 Blood, l/r, irradiated
9530 Plate pheres leukoredu irrad
9531 Plt, pher, l/r cmv-neg, irr
9532 RBC, frz/deg/wsh, l/r, irrad
9533 RBC, l/r, cmv-neg, irrad
9534 Pathogen reduced plasma pool
9535 Pathogen reduced plasma sing
9536 Platelets pheresis path redu
9537 Blood component/product noc
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