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
9206   Inj plasminogen tvmh 1mg
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
9538   Plasma cryo redu path each
9540   Covid-19 convalescent plasma
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