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

Payments for Bone Marrow and Stem Cell Processing Services

CMS has proposed to recognize for the first time, in 2008, bone marrow/stem cell processing codes 38207-38215. AABB, along with the American Society of Hematology and the American Society for Blood and Marrow Transplant, had urged CMS to recognize these codes and establish fair payments for these procedures. The proposed payment rate for Codes 38207-38209 (cryopreservation and thawing codes) is $54.69 (compared with $14.11 now), and the proposed payment for Codes 38210-38215 (cell depletion codes) is $222.44 (compared with $212.58). CMS noted that when it receives charge data for the individual cell depletion codes in subsequent years, the agency will be able to distinguish between the costs of the various procedures and set more appropriate payments.

CMS has proposed a dramatic 63 percent increase in payment for bone marrow collection and related procedures (Codes 38230, 38240 and 38241) from $1,251.38 in 2007 to $2,035.93 in 2008. Hospitals also would be paid this same $2,035.93 figure for other apheresis and photopheresis-related procedures included under the same APC code (0112).

The following table compares 2007 payment rates for blood transfusion and cellular therapy procedures with CMS’ proposed 2008 payments for these services:

2008 Proposed HOPPS Procedural Payments

AABB will submit comments to CMS regarding the proposed rule. The proposed rule will be posted in the August 2, 2007 edition of the Federal Register.