AHA Coding Clinic® for HCPCS - 2005 Issue 2
CMS adds section for billing policies regarding blood and blood products
Section 231, Billing and Payment for Blood and Blood Products under the Hospital Outpatient Prospective Payment System, has been created and added to the Medicare Claims Processing Manual, Pub. 100-04, Chapter 4, to provide and clarify billing instructions for blood and blood products under the OPPS. Section 231 includes billing instructions regarding the use of new HCPCS modifier BL, billing policies on billing for autologous blood and directed donor blood, split units of blood, irradiation of blood products, frozen and thawed blood and blood products, unused blood, transfusion services, pheresis and apheresis services, and correct coding initiative edits. Providers...
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Article Overview
This article explains a CMS manual update that adds Section 231 to the Medicare Claims Processing Manual for Hospital Outpatient Prospective Payment System billing of blood and blood products. It is relevant to outpatient hospitals, billing staff, and coding professionals who need a high-level view of the policy areas covered, including modifier usage, product handling scenarios, transfusion-related services, and related claims-edit references.
Why This Topic Matters
The update affects how outpatient providers report and process claims for blood-related services under OPPS. Understanding the scope of the guidance helps billing and coding teams identify whether the article addresses their workflow, claims reporting, or compliance needs.
Article Sections
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Section 231 overview
Introduces the manual section added for OPPS billing and payment of blood and blood products and notes the effective date referenced in the article.
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Modifier BL and revenue codes 038X, 0390 and 0399
Summarizes claims-reporting topics tied to blood product billing, processing and storage charges, and related outpatient claims handling.
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Autologous blood and directed donor blood
Covers outpatient billing considerations for blood collection and transfusion scenarios involving patient-specific or directed-donor blood.
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Billing for split unit of blood
Describes the section addressing split-unit billing and related transfusion service reporting.
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Billing for irradiation of blood products
Summarizes the portion of the guidance that addresses irradiated blood product billing and associated coding references.
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Billing for frozen and thawed blood and blood products
Covers outpatient billing topics for blood products that are frozen, thawed, or both, and the related claims-reporting framework.
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Billing for unused blood
Addresses handling of charges and cost reporting when blood products are prepared but not used.
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Billing for transfusion services
Summarizes claims reporting for transfusion-related services and the associated outpatient payment context.
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Billing for pheresis and apheresis services
Covers the section on visit-based billing for pheresis and apheresis services and related evaluation and management considerations.
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Correct coding initiative (CCI) edits
Notes the article’s discussion of CCI edit checks and where providers are directed to review current information.
What You Will Learn
- What CMS guidance the manual update adds for outpatient blood and blood product claims
- Which broad billing scenarios are addressed in the new section
- How the article frames blood-product claims, transfusion services, and related edit references
- Which general provider groups and billing workflows the update may affect
Who Should Read This
- Hospital outpatient billing staff
- Medical coders
- Revenue cycle teams
- Compliance personnel
- OPPS providers
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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