1.0 CPT 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 (Current Procedural Terminology (CPT)
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 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.