Pathology And Laboratory
Chapter 6
Section 2.1
Transfusion Services For
Whole Blood, Blood Components, And Blood Derivatives
Issue Date: March 27, 1991
Copyright: CPT
only © 2006 American Medical Association (or such other date of
publication of CPT).
All Rights Reserved.
Revision:
1.0 CPT
PROCEDURE CODES
36430 - 36460, 86077 - 86079,
86900 - 86906, 86920 - 86922
2.0
DESCRIPTION
Transfusions are the introductions of either
whole blood, and blood components (red cells, platelets, plasma,
or leukocytes), or blood derivatives (albumin, gamma globulin, Factors
VIII and IX, or Rho (D) Immune Globulins (RhoGAM), and prothrombin)
directly into the bloodstream. Transfusion services are those services
necessary to test donor blood and administer transfusions. Transfusion services
include equipment, supplies, storage, administration, processing,
typing and cross-matching.
3.0 POLICY
3.1 Whole blood
and blood components are covered when the whole blood and blood components
are actually administered to the patient.
3.2 Transfusion services for whole
blood and blood components are covered as supplies or laboratory
services for transfusions of both allogeneic and autologous blood
when the whole blood or blood components are used by the patient.
3.3 Blood derivatives,
outlined in
paragraph 2.0, which are classified as formulary
drugs are covered as prescription drugs.
4.0 EXCLUSIONS
4.1 Blood typing
for paternity testing (CPT procedure codes 86910and 86911) is not
covered.
4.2 Unused whole blood and blood components are
not covered.
4.3 Preoperative collection, processing, and storage
of autologous blood (CPT procedure codes 86890 and 86891) are included
within the Diagnosis Related Group (DRG) payment. No separate payment
is allowed. Charges for the collection and storage of autologous
blood by other than an inpatient facility are to be reimbursed by
the inpatient facility since they are included in the DRG payment.
This policy does not apply to claims for outpatient services.
4.3.1 The testing
of autologous blood is not covered.
4.3.2 Transfusion services for autologous
blood and blood components in the absence of a scheduled covered
surgical procedure is not covered.
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