Billing for Blood Products and Related Services: Frequently Asked Questions

According to the CPT manual, CPT code 86902 (Blood typing; antigen testing of donor blood using reagent serum, each antigen test) should be reported for each antigen for each blood unit tested. Therefore, providers should determine the units of service for CPT code 86902 by multiplying the number of antigens by the number of blood units screened. Three examples are provided below:

Yes. As explained in the response to the previous question, the units of service for CPT code 86902 should be determined by multiplying the number of antigens by the number of blood units screened (not the number of blood units transfused). Therefore, it is appropriate to report CPT code 86902 for all blood units screened, regardless of whether the units end up being transfused to the patient.

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Although CMS provides instructions on billing for irradiated units in its OPPS blood billing guidelines (see page 19 of the AABB Billing Guide), the guidelines do not address the issue of how to handle situations in which irradiated units are not specifically ordered. Therefore, each hospital must make the ultimate determination regarding how to bill for irradiated units in this scenario.

That said, many hospitals will not use an irradiated P-code if a patient did not require irradiated units. In these situations, the hospital will typically “downcode” and bill the corresponding non-irradiated P-code. This approach may present administrative challenges (in terms of matching the HCPCS code to the product inventory), and there unfortunately is no easy answer for how to address these challenges. In some cases, a manual workaround may be required if a hospital’s automated system will not allow for proper coding.

Hospitals may wish to develop their own internal policies that specify how to handle situations such as the scenario described above. Hospitals should follow their policies consistently and should be prepared to defend the policies (based on clinical factors) in the event of an audit. 

There is no plasma code that includes “liquid” in the descriptor. Therefore, hospitals would need to review the available P-codes for plasma and select the code that most closely describes the product being transfused. There is no single right answer; since there is not an exact match, each hospital must make its own determination as to which code is most appropriate. The complete list of available P-codes is available in Appendix I of the AABB Billing Guide.

For confirmatory testing, it would not be appropriate to bill for the second round of testing, even if it is a regulatory requirement.

Medicare and other payers generally do not allow hospitals to bill separately for additional testing that is confirmatory in nature. Therefore, if a test is repeated solely to confirm the results of a previous test, then only one of the tests can be billed. Hospitals could include the cost of the second test in their processing charge for the blood unit (billed with revenue code 0390 plus the blood product P-code in the hospital outpatient setting), but this would not result in additional reimbursement.

It would be appropriate to bill the following CPT codes if all three phases of crossmatching are performed:

• 86920 – Compatibility test each unit, immediate spin technique
• 86921 – Compatibility test each unit, incubation technique
• 86922 – Compatibility test each unit, antiglobulin technique

Although there also is a code for electronic crossmatching (86923 – Compatibility test each unit, electronic), current National Correct Coding Initiative (NCCI) edits prevent this code from being paid separately when billed with any of the three crossmatching codes listed above.

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There is no platelet P-code that includes “washed” in the descriptor, and it is not possible to bill separately for washing using a CPT code. Therefore, hospitals would need to use whichever platelet P-code best describes the product being transfused, minus the washing. The complete list of available P-codes is available in Appendix I of the AABB Billing Guide.

Although there is no specific HCPCS P‐code to describe pooled blood products, hospitals could bill one unit of CPT code 86965 (Pooling of platelets or other blood products) for the pooling, and the appropriate number of units of the applicable P‐code for the blood product.

For example, if a hospital uses a pooled product that includes five units of leukoreduced platelets, the facility could bill:

• one unit of pooling CPT code 86965, and
• five units of HCPCS code P9031 (Platelets, leukoreduced, each unit).

Note: P9031 is only an example – hospitals should use whichever P-code best describes the type of blood product being transfused. 

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In general, hospitals may bill for patient-specific laboratory services performed on blood units (such as crossmatching), even when such services are performed by the blood supplier; this practice is known as providing services “under arrangements.” Information on Medicare’s requirements for services to be covered under arrangements can be found in Section 10.3 of Chapter 5 of the Medicare General Information, Eligibility, and Entitlement Manual.