Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)
Policy #:MA06.020a

This policy is applicable to the Company’s Medicare Advantage products only. Policies that are applicable to the Company’s commercial products are accessible via a separate commercial policy database.


The Company makes decisions on coverage based on the Centers for Medicare and Medicaid Services (CMS) regulations and guidance, benefit plan documents and contracts, and the member’s medical history and condition. If CMS does not have a position addressing a service, the Company makes decisions based on Company Policy Bulletins. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable. Although the Medicare Advantage Policy Bulletin is consistent with Medicare’s regulations and guidance, the Company’s payment methodology may differ from Medicare.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.


This Policy Bulletin document describes the status of CMS coverage, medical terminology, and/or benefit plan documents and contracts at the time the document was developed. This Policy Bulletin will be reviewed regularly and be updated as Medicare changes their regulations and guidance, scientific and medical literature becomes available, and/or the benefit plan documents and/or contracts are changed.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's Evidence of Coverage.

Autologous blood services (including collection, storage, transfusion, and perioperative salvage) are covered and eligible for reimbursement consideration by most Company Medicare Advantage products when provided in conjunction with a planned episode of care that requires transfusion, including, but not limited to, surgical procedures. Benefits are provided for the storage of autologous blood until the scheduled date of care, with the following clarification:
  • When the transfusion occurs in a participating facility setting, the associated charges for the transfusion are included in the facility reimbursement.

Policy Guidelines

This policy is consistent with Medicare's coverage determination.

Autologous blood collection, storage, and transfusion are not considered routine pre-admission testing services.

Description

Autologous blood collection and storage allows an individual to have has his/her own blood drawn and stored for personal use, such as self-donation in advance of a planned surgical procedure (preoperative).

Autologous blood transfusion is the precollection and subsequent infusion of an individual's own blood.

Perioperative blood salvage is the collection and reinfusion of blood lost during and immediately after surgery.
References

Centers for Medicare and Medicaid Services (CMS). National Coverage Determination (NCD).110.7: Blood transfusions. [CMS Web site]. 12/08/1994. Available at: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=154&ncdver=1&bc=BAABAAAAAAAA&. Accessed July 26, 2018.

Evidence of Coverage.


Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

36430, 86890, 86891


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements






Policy History

Revisions from MA06.020a:
08/29/2018The policy has been reviewed and reissued to communicate the Company’s continuing coverage and reimbursement position for the collection, storage, and subsequent transfusion of autologous blood.
11/23/2016The policy has been reviewed and reissued to communicate the Company’s continuing coverage and reimbursement position for the collection, storage, and subsequent transfusion of autologous blood.
07/01/2015The policy has been reviewed and reissued to communicate the Company’s continuing coverage and reimbursement position for the collection, storage, and subsequent transfusion of autologous blood.

Revisions from MA06.020:
01/01/2015This is a new policy.





Version Effective Date: 07/01/2015
Version Issued Date: 07/02/2015
Version Reissued Date: 08/29/2018