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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 , 3651336514, 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, 8834688347, 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.