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CMS Proposed 2010 HOPPS Payments Include Decreases for Certain Blood Products and Very Modest Increases for Stem Cell Processing

Under a proposed rule for 2010 Medicare payments for hospital outpatient services, the Centers for Medicare and Medicaid Services (CMS) has proposed very small increases and in some instances modest decreases in payments for the most frequently transfused blood products. However, the agency proposes significant decreases in the payments for some infrequently used blood products. Proposed payments for laboratory bone marrow/stem cell processing codes modestly increase, but still lag notably below the actual costs of these services. Comments on the proposed rule are due to CMS by August 31.

Payments for Blood Products

The following table compares the proposed 2010 payment rates for blood products with current Medicare payment rates:

Payments for Blood Components

HCPCS

Description

2009
Final
APC

2010
Proposed
APC

2009 Final Payment Rate
2010
Proposed
Payment
Rate
%Change
P9010

Whole blood for transfusion

0950
0950
$230.40
$207.95
-9.74%
P9011

Blood split unit

0967
0967
$31.12
$91.05
192.58%
P9012

Cryoprecipitate each unit

0952
0952
$42.46
$44.84
5.61%
P9016

RBC leukocytes reduced

0954
0954
$188.92
$187.93
-0.52%
P9017

Plasma 1 donor frz w/in 8 hr

9508
9508
$76.73
$75.28
-1.89%
P9019

Platelets, each unit

0957
0957
$73.25
$66.20
-9.62%
P9020

Platelet rich plasma unit

0958
0958
$394.95
$148.82
-62.32%
P9021

Red blood cells unit

0959
0959
$136.82
$141.53
3.44%
P9022

Washed red blood cells unit

0960
0960
$261.64
$270.09
3.23%
P9023

Frozen plasma, pooled, sd

0949
0949
$58.83
$53.49
-9.08%
P9031

Platelets leukocytes reduced

1013
1013
$111.67
$114.45
2.49%
P9032

Platelets, irradiated

9500
9500
$164.42
$160.12
-2.62%
P9033

Platelets leukoreduced irrad

0968
0968
$128.19
$126.00
-1.71%
P9034

Platelets, pheresis

9507
9507
$468.66
$461.09
-1.62%
P9035

Platelet pheres leukoreduced

9501
9501
$514.82
$519.79
0.97%
P9036
Platelet pheresis irradiated
9502
9502
$469.53
$358.24
-23.70%
P9037

Plate pheres leukoredu irrad

1019
1019
$653.50
$673.01
2.99%
P9038

RBC irradiated

9505
9505
$250.69
$221.84
-11.51%
P9039

RBC deglycerolized

9504
9504
$341.43
$330.90
-3.08%
P9040

RBC leukoreduced irradiated

0969
0969
$251.33
$252.91
0.63%
P9043

Plasma protein fract,5%,50ml

0956
0956
$15.62
$57.92
270.81%
P9044

Cryoprecipitatereduced plasma

1009
1009
$85.16
$94.58
11.06%
P9048

Plasmaprotein fract,5%,250ml

0966
0966
$196.27
$110.16
-43.87%
P9050

Granulocytes, pheresis unit

9506
9506
$1,669.99
$48.64
-97.09%
P9051

Blood, l/r, cmv-neg

1010
1010
$144.13
$146.73
1.80%
P9052

Platelets, hla-m, l/r, unit

1011
1011
$711.89
$720.24
1.17%
P9053

Plt, pher, l/r cmv-neg, irr

1020
1020
$649.24
$685.09
5.52%
P9054

Blood, l/r, froz/degly/wash

1016
1016
$101.68
$97.80
-3.82%
P9055

Plt, aph/pher, l/r, cmv-neg

1017
1017
$480.41
$408.02
-15.07%
P9056

Blood, l/r, irradiated

1018
1018
$226.31
$194.91
-13.87%
P9057

RBC, frz/deg/wsh, l/r, irrad

1021
1021
$424.67
$417.10
-1.78%
P9058

RBC, l/r, cmv-neg, irrad

1022
1022
$301.43
$281.53
-6.60%
P9059

Plasma, frz between 8-24hour

0955
0955
$75.62
$80.87
6.94%
P9060

Fr frz plasma donor retested

9503
9503
$64.25
$61.57
-4.17%

Payments for Bone Marrow and Stem Cell Processing Services

CMS has proposed very modest increases in payments for bone marrow/stem cell processing codes 38207-38215, which were first recognized by the agency in 2008. The proposed payment rate for Codes 38207-38209 (cryopreservation and thawing codes) is $226.60 (compared with $221.59 now), and the proposed payment for Codes 38210-38215 (cell depletion codes) is $409.25 (compared with $400.19). It should be noted that since these payments are based on 2008 claims data, any more recent adjustments that hospitals have made in their charging practices are not yet reflected in CMS’ payments. Hospitals are encouraged to take steps now to ensure that their charges accurately reflect the actual costs of providing these services since CMS will base future payments on such charge data.

The following table compares 2009 payment rates for transfusion and cellular therapy procedures with CMS’ proposed 2010 payments for these services:

Payments for Procedural Codes

CPT/ HCPCS
Description
2009 Final APC
2010
Proposed
APC
2009
Final
Payment
Rate
2010
Proposed
Payment
Rate
%Change
36430

Blood transfusion service

0110
0110
$221.59
$226.60
2.26%
36440

Bl push transfuse, 2 yr or <

0110
0110
$221.59
$226.60
2.26%
36450

Bl exchange/transfuse, nb

0110
0110
$221.59
$226.60
2.26%
36455

Bl exchange/transfuse non-nb

0110
0110
$221.59
$226.60
2.26%
36511

Apheresis wbc

0111
0111
$759.70
$818.57
7.75%
36512

Apheresis rbc

0111
0111
$759.70
$818.57
7.75%
36513

Apheresis platelets

0111
0111
$759.70
$818.57
7.75%
36514

Apheresis plasma

0111
0111
$759.70
$818.57
7.75%
36515

Apheresis, adsorp/reinfuse

0112
0112
$2,033.73
$2,119.73
4.23%
36516

Apheresis, selective

0112
0112
$2,033.73
$2,119.73
4.23%
36522

Photopheresis

0112
0112
$2,033.73
$2,119.73
4.23%
38206

Harvest auto stem cells

0111
0111
$759.70
$818.57
7.75%
38207

Cryopreserve stem cells

0110
0110
$221.59
$226.60
2.26%
38208

Thaw preserved stem cells

0110
0110
$221.59
$226.60
2.26%
38209

Wash harvest stem cells

0110
0110
$221.59
$226.60
2.26%
38210

T-cell depletion of harvest

0393
0393
$400.19
$409.25
2.26%
38211

Tumor cell deplete of harvest

0393
0393
$400.19
$409.25
2.26%
38212

Rbc depletion of harvest

0393
0393
$400.19
$409.25
2.26%
38213

Platelet deplete of harvest

0393
0393
$400.19
$409.25
2.26%
38214

Volume deplete of harvest

0393
0393
$400.19
$409.25
2.26%
38215

Harvest stem cell concentrate

0393
0393
$400.19
$409.25
2.26%
38220

Bone marrow aspiration

0003
0003
$208.26
$211.31
1.46%
38221

Bone marrow biopsy

0003
0003
$208.26
$211.31
1.46%
38230

Bone marrow collection

0112
0112
$2,033.73
$2,119.73
4.23%
38241

Bone marrow/stem transplant

0112
0112
$2,033.73
$2,119.73
4.23%
88184

Flowcytometry/ tc, 1 marker

0433
0433
$16.50
$16.64
0.85%
88185

Flowcytometry/tc, add-on

0433
0433
$16.50
$16.64
0.85%
88187

Flowcytometry/read, 2-8

0342
0342
$10.06
$10.68
6.16%
88188

Flowcytometry/read, 9-15

0343
0343
$34.55
$35.70
3.33%
88189

Flowcytometry/read, 16 & >

0343
0343
$32.75
$35.70
9.01%
G0364

Bone marrow aspirate &biopsy

0340
0340
$42.69
$45.06
5.55%


CMS proposes not to pay for the costs of harvesting and transplanting allogeneic stem cells in the outpatient setting. According to CMS, “Allogeneic transplants performed on Medicare beneficiaries are provided on an inpatient basis, and all services related to acquiring the stem cells from a donor (whether performed inpatient or outpatient) are billed and are payable under Medicare Part A through the IPPS MS-DRG payment for the stem cell transplant.”

AABB will submit comments to CMS regarding the proposed rule. The proposed rule will be posted in the July 20, 2009 edition of the Federal Register.