Notification



Notification Issue Date:



Claim Payment Policy


Title:Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)

Policy #:06.03.05e

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

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.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.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

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

Autologous blood services (including collection, storage, transfusion, and perioperative salvage) are covered and eligible for reimbursement consideration by most Company products and groups 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:
  • Individual benefits must be verified, as coverage may vary by product and/or group.

When the transfusion occurs in a participating facility setting, the associated charges for the transfusion are included in the facility reimbursement.
Guidelines

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

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, autologous blood services (including collection, storage, transfusion, and perioperative salvage) are covered under the medical benefits of the Company's products.

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 29, 2018.


Company Benefit Contracts.



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


Cross References


Policy History

Revisions from 06.03.05e:
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.


Effective 10/05/2017 this policy has been updated to the new policy template format.


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

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.