Blood Community Urges CMS to Improve Coverage of Prehospital Blood Transfusion

AABB, America’s Blood Centers (ABC) and the American Red Cross (ARC) issued a joint letter to the Centers for Medicare and Medicaid Services (CMS) this week urging the agency to take steps to expand access to prehospital blood transfusion.

In a proposed rule updating Medicare part B payment and coverage policies for calendar year 2025, CMS announced plans to add the administration of low titer O+ whole blood (LTOWB) transfusion to the current list of advanced life support, level 2 (ALS2), procedures. However, the proposal does not include other life-saving blood products.

In comments to CMS Administrator Chiquita Brooks-LaSure, the blood community expressed concern that the agency’s proposed policy will not ensure adequate access to prehospital blood transfusions. To address this, the blood community recommended several steps to expand access.

First, the blood community urged CMS to provide coverage for all Food and Drug Administration-approved blood and blood components provided in the prehospital setting of care. The letter cited operational challenges faced by EMS providers that could hinder the availability of LTOWB and other components, stressing the need for broader coverage of all blood products.

The letter also addressed the inadequacy of current ALS2 payment rates, which are insufficient to cover the high costs of blood transfusions. As an example, the letter highlighted Maryland’s prehospital transfusion programs, noting that only well-funded EMS agencies can afford these services under current reimbursement rates. The blood community also underscored the need for aligned reimbursement policies to support the widespread adoption of these programs.

Finally, the blood community encouraged CMS to develop and implement a payment and service delivery model through the CMS Innovation Center that incorporates prehospital blood transfusions into the emergency medical system. Implementing such a model could improve emergency care, reduce costs and enhance patient outcomes by covering the costs of procuring, storing and administering blood transfusions. Comprehensive reimbursement policies would also lower hemorrhagic deaths and long-term hospitalizations.

Additionally, AABB, as part of the Prehospital Blood Transfusion Initiative Coalition, joined clinicians and partner organizations from across the health care community in urging CMS to consider all FDA-approved blood and blood components as reimbursable under the ambulance fee schedule (AFS). The coalition also asked the agency to provide additional funding to support the addition of these products to the AFS and to include air ambulances in the proposal. Members can learn more about the Prehospital Blood Transfusion Initiative Coalition online.

Additional information about AABB’s efforts to expand access to blood and biotherapies products is available on AABB’s Coverage and Reimbursement web page.