July 18, 2007

CMS Proposed 2008 HOPPS Payments Include Modest Increases for Blood Products, Notable Improvements for Some Cellular Therapy Procedures

Under a proposed rule for 2008 Medicare payments for hospital outpatient services, the Centers for Medicare and Medicaid Services, has proposed modest payment increases for most frequently transfused blood products. However, reimbursement for many blood products and services would continue to lag behind actual costs. CMS proposed more dramatic increases for some bone marrow and stem cell related procedures and for the first time has agreed to recognize certain CPT codes for bone marrow/stem cell processing.  

Payments for Blood Products 

For calendar year 2008, CMS has proposed payments for blood and blood products based on simulated medians calculated using CY 2006 hospital claims data. For example, CMS proposes to pay $188.47 for a unit of leukocyte-reduced red blood cells, compared with its $175.74 payment in 2007. However, the actual average hospital acquisition cost for a unit of leukocyte-reduced RBCs is significantly higher than the proposed 2008 CMS payment. Overall, payments would be increased for most blood products, particularly the most frequently transfused products. Payments for 25 of the 34 blood products would increase under the CMS proposal. 

The following table compares the proposed 2007 payment rates for blood products with current Medicare payment rates: 

Payments for Blood Components