Laboratory Question for the Week of January 30, 2017

Laboratory Compliance Question of the Week

Question:

For Medicare outpatients, how are blood products paid?

Answer:

As described by the Centers for Medicare & Medicaid Services (CMS), codes in the following categories are paid under a reasonable-charge basis:
• Blood products
• Transfusion medicine
• Reproductive medicine.

As CMS states in transmittal 3687CP, the reasonable charge may not exceed the lowest of the actual charge or the customary or prevailing charge for the previous 12-month period ending June 30, updated by the inflation-indexed update, which is 1 percent for 2017.

When these services are performed for hospital-based renal dialysis facility patients, payment is made on a reasonable cost basis. Also, when these services are performed for hospital outpatients, payment
is made under the hospital outpatient prospective payment system (OPPS).

A list of codes paid and other details of this payment can be found in transmittal R3687CP at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3687CP.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.