AABB Billing and Reimbursement Initiatives
AABB is committed to seeking enhanced and fair reimbursement for blood products, and transfusion services and cellular therapies through both education regarding the complexities of blood coding and billing, and advocacy to reimbursement policy makers.
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AABB Billing Guide
Billing for Blood and Transfusion Services FAQ
Billing and Reimbursement for Stem Cell Processing Q & A
Reimbursement Advocacy
News
NEW: Frequently Asked Questions and Answers Regarding Billing for Stem Cell Processing
AABB consulted experts to provide responses to frequently asked member questions regarding the billing and coding of stem cell processing, particularly in light of Medicare's recent recognition of certain stem cell processing codes. Although providers are always advised to consult individuals at their institutions who are responsible for coding and billing as well as the Medicare contractors for their geographical locations to determine correct coding and billing, these FAQs provide helpful information.
NEW: Proposed 2009 HOPPS Payments Include Modest Increases for Most Blood Products and Cellular Therapy Procedures
Under a proposed rule for 2009 Medicare payments for hospital outpatient services, the Centers for Medicare and Medicaid Services (CMS), 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. In addition, Medicare payments for bone marrow and stem cell procedures would remain woefully inadequate, despite small proposed payment increases for such services. AABB has prepared a summary of the proposed rule's treatment of blood products and transfusion and cellular therapy procedures.
Summary of 2008 Medicare Outpatient Payments for Blood Products and Stem Cell Processing
AABB has prepared a summary of the 2008 Medicare Hospital Outpatient Prospective Payment System rule, providing details about the payment rates for blood products, cellular therapy services, clotting factors and IVIG. The final rule — issued this month by the Centers for Medicare and Medicaid Services — calls for increases to payments for several bone marrow and stem cell processing services. The increases were made in response to concerns raised by AABB and others, although they are lower than requested. Providers are urged to bill using the new stem cell processing codes so that CMS can obtain better cost data to help determine payments for these services in the future. Payments for most blood products increased modestly compared to 2007 rates. The new payment system takes effect Jan. 1, 2008.
AABB Issues Updated Billing Guide for Transfusion and Cellular Therapy Services
AABB has posted an updated version 4.0 of the AABB Billing Guide for Transfusion and Cellular Therapy Services. The Billing Guide provides updated information and references for Medicare policies and guidance relating to blood. Throughout the Billing Guide, all coding systems – including revenue codes, CPT, HCPCS, and ICD-9-CM – have been updated to reflect the most recent changes. In addition, this revised Billing Guide provides updated information on appropriate coding and billing for hematopoietic progenitor cell collection and processing, including information regarding Medicare’s recent proposal to recognize certain stem cell processing codes for the first time (see Section VIII). The Billing Guide also contains information regarding billing and coding for apheresis, blood derivatives, tissue and bone.
NEW: Frequently Asked Questions and Answers Regarding Billing for Blood and Transfusion Services
AABB consulted several experts to provide responses to frequently asked member questions regarding the billing and coding of blood products and transfusion services reimbursable under the Medicare program. These FAQs address a broad range of billing and coding issues, including billing for autologous blood, split, irradiated or frozen units, and transfusion services. Although providers are always advised to consult individuals at their institutions who are responsible for coding and billing as well as the Medicare contractors for their geographical locations to determine correct coding and billing, these frequently asked questions and answers provide helpful information relating to Medicare billing policies.
CMS Responds to Inquiry Regarding Appropriate Billing for Blood and Related Services
The Centers for Medicare and Medicaid Services (CMS) has responded to a request from the blood banking community for clarification of agency guidance regarding billing for blood and related services. In late 2005, AABB, the American Red Cross (ARC), America’s Blood Centers (ABC) and the Advanced Medical Technology Association (AdvaMed) wrote to CMS commenting on CMS Transmittal 496 (March 4, 2005) and providing recommendations for improved guidance related to both outpatient and inpatient reimbursement for blood products and services. AABB has summarized CMS’ responses to the blood community, as included in a September 29, 2006, letter to AABB.
Blood community’s letter to CMS (PDF)
CMS September 29, 2006 letter (PDF)
Archived News
AABB Billing Guide
AABB has posted an updated version 4.0 of the AABB Billing Guide for Transfusion and Cellular Therapy Services.
AABB’s Billing Guide is intended to assist hospitals, clinicians, billing and coding professionals involved with the utilization and subsequent billing of the services and procedures associated with the use of blood and transfusion and cellular therapies. AABB produced this guide with the generous support and cooperation of the blood sector member companies of the Advanced Medical Technology Association (AdvaMed).
The Billing Guide provides updated information and references for Medicare policies and guidance relating to blood. Throughout the Billing Guide, all coding systems – including revenue codes, CPT, HCPCS, and ICD-9-CM – have been updated to reflect the most recent changes.
In addition, this revised Billing Guide provides updated information on appropriate coding and billing for hematopoietic progenitor cell collection and processing, including information regarding Medicare’s recent proposal to recognize certain stem cell processing codes for the first time (see Section VIII). The Billing Guide also contains information regarding billing and coding for the following additional products and services:
- Apheresis – Section VIII
- Blood Derivatives – Section VI
- Tissue and Bone – Section VI
Many U.S. hospitals do not bill accurately, or at all, for blood transfused in the inpatient setting. Failure to bill appropriately for blood can hinder patient access to new technologies and potentially can affect the hospital’s bottom line. The Billing Guide is intended to help hospitals bill accurately and completely for blood products and services. Though AABB does not provide any guarantees of reimbursement, the intent of this publication is to assist hospitals in understanding the billing rules and procedures that apply for Medicare and other payers.
The AABB Billing Guide is available below in PDF format for viewing and printing:
AABB Billing Guide – Version 4.0 (PDF)
AABB will post periodic updates to this guide in this section as Medicare or other reimbursement and coding policies relating to blood are revised. Please check this page periodically for updates.
Reimbursement Advocacy
AABB serves as a leading advocate before the Centers for Medicare and Medicaid Services (CMS) and Congress regarding the need for fair and timely Medicare reimbursement for blood products and services and cellular therapies. In the inpatient arena, AABB, along with others in the blood community, has supported efforts to allow Medicare to better account for the increasing cost of blood. In particular, AABB asked Congress and CMS to create a new blood-related producer price index (PPI) to be used in calculating the change in prices for goods and services hospitals use to provide inpatient care (the so-called "market basket"). In recent years, the cost of blood had been inappropriately bundled in unrelated indices for "chemicals" or ”miscellaneous goods.” In response, the Bureau of Labor Statistics is currently collecting data from blood centers to establish a separate PPI for blood and organ banks. AABB and its fellow blood organizations will continue to work to ensure that CMS adopts the new blood PPI and that this index does, in fact, reflect changes in blood costs as accurately as possible.
In the realm of outpatient reimbursement, AABB was a staunch advocate for separate ambulatory payment classifications (APCs) for individual blood products and services when CMS first established the APC outpatient prospective payment system in 1998. AABB continues to support improvements in the APC system to ensure it accurately accounts for the costs of blood and reflects the increasingly complex array of blood products and services. Specifically, AABB has urged CMS to use outside cost data provided by hospitals and blood centers to establish its outpatient payment rates for blood products, rather than continuing to rely on faulty CMS data.
In response to AABB’s requests, CMS issued revised guidance regarding billing for blood under the hospital outpatient prospective payment system, which took effect July 2005. This guidance can be found at http://new.cms.hhs.gov/transmittals/downloads/R496CP.PDF. AABB, along with others in the blood banking community, continue to urge CMS to further update and improve its guidance regarding blood-related reimbursement.
AABB also is a strong advocate for improved Medicare reimbursement for bone marrow, hematopoietic progenitor cells and apheresis-related procedures. AABB, along with other interested organizations, have urged CMS to adjust its payments to hospitals for laboratory processing services associated with bone marrow and peripheral blood progenitor cell transplants to reflect their actual costs.
Finally, AABB has championed new or improved Current Procedural Terminology (CPT) codes for transfusion medicine and cellular therapy-related procedures. For example, in response to requests from AABB, the American Medical Association in 2005 issued new CPT codes for a pretransfusion electronic crossmatch test (86923) and for volume reduction of blood products (86960).
Free Monthly Email Updates
AABB is developing a national contact list of interested parties who wish to receive the latest information on billing and reimbursement for blood products, transfusion services and cellular therapies. Interested parties will receive free monthly updates on revised Medicare policies and appropriate coding for blood and transfusion therapies. This information will assist facilities in dealing with the complexities and changes in reimbursement policies. Interested parties will receive information about audioconferences and other educational forums focusing on billing and reimbursement. In addition, email recipients will receive answers to frequently asked billing questions.
If you are interested in receiving these monthly updates, please sign up here.
If you have questions relating to billing and reimbursement for blood products and services, please contact govt&legal@aabb.org .
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