CMS Releases Final Outpatient Rule and Payment Rates for Blood and Blood Products

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CMS Releases Final Outpatient Rule and Payment Rates for Blood and Blood Products

The Centers for Medicare and Medicaid Services (CMS) recently announced its final 2007 payment rates for blood and transfusion, bone marrow and hematopoietic stem cell related services provided in the outpatient setting. The rates, which take effect Jan. 1, 2007, were published in the agency’s hospital outpatient prospective payment system (HOPPS) rule for calendar year 2007.

AABB had submitted comments to CMS regarding this rule, specifically noting concerns regarding Medicare’s proposed payment for leukocyte-reduced red blood cells (RBCs) and other frequently transfused blood products. In the comments, AABB noted that CMS’ proposed 2007 payment for leukocyte-reduced RBCs was only $176. In contrast, the U.S. Department of Health and Human Services (HHS) recently published nationwide data in the 2005 Nationwide Blood Collection and Utilization Survey Report indicating that the average hospital payment for leukocyte-reduced RBCs in 2004 was already $201.07 – 13.6 percent higher than the proposed 2007 payment. AABB recommended that CMS base its outpatient payment rate for this product on the 2004 HHS cost data increased by 10 percent (due to inflationary costs and the introduction of new blood safety measures), or $221.18. However, in the final rule, CMS failed to increase its proposed payments for leukocyte-reduced RBCs or other frequently transfused components.

The following tables list Medicare’s 2007 payment rates for blood components as well as transfusion, bone marrow and hematopoietic progenitor cell (HPC) related procedures.

Payments for Blood Components

HCPCS	APC	Product/Service	2006 Final Payment Rate	2007 Final Payment Rate	% Change
P9010	0950	Blood (whole) for transfusion	$118.04	$131.98	11.8%
P9012	0952	Cryoprecipitate	$47.15	$48.59	3.1%
P9016	0954	RBCs, leukocytes reduced	$163.33	$175.74	7.6%
P9017	9508	Plasma 1 donor frz w/in 8 hr	$70.47	$70.21	-0.4%
P9019	0957	Platelet Concentrate	$51.55	$58.95	14.4%
P9020	0958	Platelet Rich Plasma	$277.73	$209.29	-24.6%
P9021	0959	Red Blood Cells	$121.61	$129.53	6.5%
P9022	0960	Washed Red Blood Cells	$189.42	$211.03	11.4%
P9023	0949	Frozen plasma, pooled, sd	$76.23	$57.45	-24.6%
P9031	1013	Platelets leukocyte reduced	$98.41	$95.08	-3.4%
P9032	9500	Platelets irradiated	$86.64	$129.57	49.6%
P9033	0968	Platelets leukocyte reduced irradiated	$150.74	$125.33	-16.9%
P9034	9507	Platelets, pheresis	$434.48	$452.93	4.3%
P9035	9501	Plaetlet pheres leukoreduced	$493.66	$488.74	-1.0%
P9036	9502	Platelet pheresis irradiated	$326.22	$418.52	28.3%
P9037	1019	Plate pheres leukoreduced irradiated	$581.64	$617.40	6.2%
P9038	9505	RBC irradiated	$147.63	$197.00	33.4%
P9039	9504	RBC deglycerolized	$343.81	$358.31	4.2%
P9040	0969	Red blood cell leukocyte reduced irradiated	$218.27	$217.56	-0.3%
P9043	0956	Plasma Protein Fraction, 5%, 50ml	$68.02	$51.26	-24.6%
P9048	0966	Plasmaprotein fract, 5%, 250ml	$316.05	$238.16	-24.6%
P9050	9506	Granulocytes, pheresis unit	$995.72	$750.36	-24.6%
P9051	1010	Blood, l/r, cmv-neg	$207.95	$156.70	-24.7%
P9052	1011	Platelets, hla-m, l/r	$610.14	$671.72	10.1%
P9054	1016	Blood, l/r, froz/degly/wash	$262.21	$211.05	-19.5%
P9055	1017	Plt, aph/pher,l/r, cmv-neg	$526.57	$396.81	-26.4%
P9056	1018	Blood, l/r, irradiated	$178.56	$144.28	-19.2%
P9057	1021	RBC, frz/deg/wsh, l/r, irradiated	$345.91	$496.21	43.5%
P9058	1022	RBC, l/r, cmv-neg, irradiated	$267.18	$262.18	-1.9%
P9059	0955	Plasma, frozen w/in 8-24 hr	$74.78	$76.77	2.7%
P9060	9503	Fr frz plasma donor retested	$94.82	$74.49	-21.4%

Payments for Blood, Bone Marrow and HPC Related Services

APC	Service	CPT/HCPCS	2006 Final Payment Rate	2007 Final Payment Rate	% Change
0003	Bone Marrow Biopsy/Aspiration	38220, 38221	$159.23	$147.59	-7.3%
0110	Transfusion	36430, 36440, 36450, 36455, 36460, 38999, G0267	$216.73	$212.58	-1.9%
0111	Blood Product Exchange	36511, 36512 , 36513 36514, 38205, 38206, 38242	$718.70	$720.00	0.2%
0112	Apheresis, Photopheresis, and Plasmapheresis	36515, 36516, 36522	$1569.60	$1857.75	18.4%
0123	Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant	38230, 38240, 38241	$1456.95	$1251.38	-14.1%
0342	Level I Pathology	80502, 81099, 84999, 85999, 86849, 87999. 88199, 88299, 88314, 88399, 89240	$8.63	$ 5.06	-41.4%
0343	Level III Pathology	85097, 86078, 88112, 88172, 88173, 88182, 88189, 88304, 88305, 88319, 88323, 88331, 88333, 88342, 88346 88347, 88355, 88360, 88385, 89049, 89220	$27.10	32.03	18.2%
0344	Level IV Pathology	88307, 88309, 88325, 88356, 88358, 88361, 88362, 88365, 88367, 88368, 88386	$45.13	$48.73	8.0%
0345	Level I Transfusion Laboratory Procedures	86850, 86903, 86905, 86906, 86921, 86923, 86927, 86945, 86950, 86960, 86970, 86971, 86976, 86985, 86999	$12.91	$13.39	3.7%
0346	Level II Transfusion Laboratory Procedures	86860, 86870, 86891, 86904, 86920, 86922, 86965, 86972, 86975, 86977, 86978	$19.72	$21.42	8.6%
0347	Level III Transfusion Laboratory Procedures	86890, 86930, 86931, 86932	$49.05	$45.63	-6.9%
0433	Level II Pathology	80500, 86077, 86079, 88104, 88106, 88107, 88108, 88125, 88160, 88161, 88162, 88184, 88185, 88187, 88188, 88300, 88302, 88311, 88312, 88313, 88318, 88321, 88329, 88332, 88334, 88384, 89230	$14.84	$15.72	5.9%

Overall, hospital outpatient departments will receive a 3.4 percent market basket update to Medicare payment rates for outpatient services in 2007. According to the American Hospital Association (AHA), hospitals receive “only 87 cents for every dollar of outpatient care they provide to America’s seniors.”

However, AHA has praised CMS for delaying until 2009 its proposed reduction in payment updates if a facility failed to report data on quality of care. Straying from its earlier proposal, the agency announced that it will implement separate quality measures specifically for the outpatient setting.

Last modified on 2/23/2007 8:48:21 AM