Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

Alert Arrow ALERT!!

MONTHLY MAINTENANCE: The DHA network is scheduled for monthly maintenance on Saturday, June 19th at 4 AM (MST) until Sunday, June 20th at 10 PM (MST). The TRICARE Manuals web site may be available intermittently during this period but its usage is not recommended.

TRICARE Policy Manual 6010.60-M, April 1, 2015
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.
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Frequently Asked Questions page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.6.7755.23747

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.