Страховые тарифы на продукты крови и трансфузиологические процедуры в 2013 году
Тарифы CMS на продукты крови и трансфузиологические процедуры амбулаторным пациентам в 2013 году
Payments for Blood Products
As shown in Table 1, payments for some of the most frequently transfused blood products will decrease in 2013. For example, the payment for leukoreduced RBCs will fall from $198.90 in 2012 to $193.24 in 2013 and the rate for leukoreduced platelets, pheresis will drop from $538.84 to $511.27.
TABLE 1 | ||||||
| CPT/ HCPCS | Description | APC | 2012 Payment Rate | 2013 Payment Rate | $ Change | % Change |
| P9010 | Whole blood for transfusion | 0950 | $190.76 | $169.83 | -$20.93 | -10.97% |
| P9011 | Blood split unit | 0967 | $117.35 | $136.36 | $19.01 | 16.20% |
| P9012 | Cryoprecipitate each unit | 0952 | $82.78 | $78.64 | -$4.14 | -5.00% |
| P9016 | RBC leukocytes reduced | 0954 | $198.90 | $193.24 | -$5.66 | -2.85% |
| P9017 | Plasma 1 donor frz w/in 8 hr | 9508 | $79.87 | $78.71 | -$1.16 | -1.45% |
| P9019 | Platelets, each unit | 0957 | $89.77 | $91.61 | $1.84 | 2.05% |
| P9020 | Platelet rich plasma unit | 0958 | $141.83 | $175.62 | $33.79 | 23.82% |
| P9021 | Red blood cells unit | 0959 | $149.16 | $151.79 | $2.63 | 1.76% |
| P9022 | Washed red blood cells unit | 0960 | $287.38 | $296.39 | $9.01 | 3.14% |
| P9023 | Frozen plasma, pooled, sd | 0949 | $66.84 | $72.23 | $5.39 | 8.06% |
| P9031 | Platelets leukocytes reduced | 1013 | $131.07 | $118.34 | -$12.73 | -9.71% |
| P9032 | Platelets, irradiated | 9500 | $128.42 | $134.23 | $5.81 | 4.52% |
| P9033 | Platelets leukoreduced irrad | 0968 | $140.00 | $156.45 | $16.45 | 11.75% |
| P9034 | Platelets, pheresis | 9507 | $442.14 | $431.99 | -$10.15 | -2.30% |
| P9035 | Platelet pheres leukoreduced | 9501 | $538.84 | $511.27 | -$27.57 | -5.12% |
| P9036 | Platelet pheresis irradiated | 9502 | $554.93 | $675.77 | $120.84 | 21.78% |
| P9037 | Plate pheres leukoredu irrad | 1019 | $691.79 | $674.16 | -$17.63 | -2.55% |
| P9038 | RBC irradiated | 9505 | $198.98 | $201.95 | $2.97 | 1.49% |
| P9039 | RBC deglycerolized | 9504 | $238.64 | $479.74 | $241.10 | 101.03% |
| P9040 | RBC leukoreduced irradiated | 0969 | $261.22 | $273.19 | $11.97 | 4.58% |
| P9043 | Plasma protein fract,5%,50ml | 0956 | $18.02 | $20.31 | $2.29 | 12.71% |
| P9044 | Cryoprecipitatereducedplasma | 1009 | $74.37 | $67.97 | -$6.40 | -8.61% |
| P9048 | Plasmaprotein fract,5%,250ml | 0966 | $72.55 | $47.16 | -$25.39 | -35.00% |
| P9050 | Granulocytes, pheresis unit | 9506 | $1,340.65 | $1,618.09 | $277.44 | 20.69% |
| P9051 | Blood, l/r, cmv-neg | 1010 | $188.55 | $185.29 | -$3.26 | -1.73% |
| P9052 | Platelets, hla-m, l/r, unit | 1011 | $803.05 | $775.45 | -$27.60 | -3.44% |
| P9053 | Plt, pher, l/r cmv-neg, irr | 1020 | $615.69 | $660.47 | $44.78 | 7.27% |
| P9054 | Blood, l/r, froz/degly/wash | 1016 | $104.95 | $122.44 | $17.49 | 16.67% |
| P9055 | Plt, aph/pher, l/r, cmv-neg | 1017 | $383.70 | $336.54 | -$47.16 | -12.29% |
| P9056 | Blood, l/r, irradiated | 1018 | $146.80 | $175.91 | $29.11 | 19.83% |
| P9057 | RBC, frz/deg/wsh, l/r, irrad | 1021 | $448.82 | $368.69 | -$80.13 | -17.85% |
| P9058 | RBC, l/r, cmv-neg, irrad | 1022 | $305.97 | $286.56 | -$19.41 | -6.34% |
| P9059 | Plasma, frz between 8-24hour | 0955 | $72.82 | $75.53 | $2.71 | 3.72% |
| P9060 | Fr frz plasma donor retested | 9503 | $80.95 | $56.82 | -$24.13 | -29.81% |
Payments for Transfusion, Apheresis and Bone Marrow/Stem Cell Procedures
As outlined in Table 2, payments for the majority of transfusion and stem cell collection and processing procedures will increase in 2013. The payment for APC 0111 (apheresis, RBC, platelets, etc. and harvest autologous stem cells) will increase from $816.59 in 2012 to $950.65 in 2013 and payment for APC 0112 (bone marrow collection, apheresis, adsorp/reinfuse, photopheresis, etc.) will rise from $2494.33 to $2888.70. AABB, along with other cellular therapy organizations, has expressed concerns in the past that CMS payments for such procedures fall notably below actual costs. Since the APC rates are based on hospital charges, it is critical that hospitals charge accurately for these procedures.
TABLE 2 | |||||||
| CPT/ HCPCS | Description | 2012 APC | 2013 APC | 2012 Payment Rate | 2013 Payment Rate | $ Change | % Change |
| 36430 | Blood transfusion service | 0110 | 0110 | $239.57 | $260.44 | $20.87 | 8.71% |
| 36440 | Bl push transfuse, 2 yr or < | 0110 | 0110 | $239.57 | $260.44 | $20.87 | 8.71% |
| 36450 | Bl exchange/transfuse, nb | 0110 | 0110 | $239.57 | $260.44 | $20.87 | 8.71% |
| 36455 | Bl exchange/transfuse non-nb | 0110 | 0110 | $239.57 | $260.44 | $20.87 | 8.71% |
| 36511 | Apheresis wbc | 0111 | 0111 | $816.59 | $950.65 | $134.06 | 16.42% |
| 36512 | Apheresis rbc | 0111 | 0111 | $816.59 | $950.65 | $134.06 | 16.42% |
| 36513 | Apheresis platelets | 0111 | 0111 | $816.59 | $950.65 | $134.06 | 16.42% |
| 36514 | Apheresis plasma | 0111 | 0111 | $816.59 | $950.65 | $134.06 | 16.42% |
| 36515 | Apheresis, adsorp/reinfuse | 0112 | 0112 | $2,494.33 | $2,888.70 | $394.37 | 15.81% |
| 36516 | Apheresis, selective | 0112 | 0112 | $2,494.33 | $2,888.70 | $394.37 | 15.81% |
| 36522 | Photopheresis | 0112 | 0112 | $2,494.33 | $2,888.70 | $394.37 | 15.81% |
| 38206 | Harvest auto stem cells | 0111 | 0111 | $816.59 | $950.65 | $134.06 | 16.42% |
| 38207 | Cryopreserve stem cells | 0110 | 0110 | $239.57 | $260.44 | $20.87 | 8.71 % |
| 38208 | Thaw preserved stem cells | 0110 | 0110 | $239.57 | $260.44 | $20.87 | 8.71% |
| 38209 | Wash harvest stem cells | 0110 | 0110 | $239.57 | $260.44 | $20.87 | 8.71% |
| 38210 | T-cell depletion of harvest | 0393 | 0393 | $484.48 | $435.79 | -$48.69 | -10.05% |
| 38211 | Tumor cell deplete of harvst | 0393 | 0393 | $484.48 | $435.79 | -$48.69 | -10.05% |
| 38212 | Rbc depletion of harvest | 0393 | 0393 | $484.48 | $435.79 | -$48.69 | -10.05% |
| 38213 | Platelet deplete of harvest | 0393 | 0393 | $484.48 | $435.79 | -$48.69 | -10.05% |
| 38214 | Volume deplete of harvest | 0393 | 0393 | $484.48 | $435.79 | -$48.69 | -10.05% |
| 38215 | Harvest stem cell concentrate | 0393 | 0393 | $484.48 | $435.79 | -$48.69 | -10.05% |
| 38220 | Bone marrow aspiration | 0003 | 0003 | $248.89 | $270.40 | $21.51 | 8.64% |
| 38221 | Bone marrow biopsy | 0003 | 0003 | $248.89 | $270.40 | $21.51 | 8.64% |
| 38230 | Bone marrow collection | 0112 | 0112 | $2,494.33 | $2,888.70 | $394.37 | 15.81% |
| 38232 | Bone marrow harvest autolog | 0112 | 0112 | $2,494.33 | $2,888.70 | $394.37 | 15.81% |
| 38240 | Bone marrow/stem transplant | 0112 | 0112 | $2,494.33 | $2,888.70 | $394.37 | 15.81% |
| 38241 | Bone marrow/stem transplant | 0112 | 0112 | $2,494.33 | $2,888.70 | $394.37 | 15.81% |
| 38242 | Lymphocyte infuse transplant | 0111 | 0111 | $816.59 | $950.65 | $134.06 | 16.42% |
| 88184 | Flowcytometry/ tc, 1 marker | 0433 | 0433 | $17.04 | $23.43 | $6.39 | 37.50% |
| 88185 | Flowcytometry/tc, add-on | 0433 | 0342 | $17.04 | $12.71 | -$4.33 | -25.41% |
| 88187 | Flowcytometry/read, 2-8 | 0342 | 0433 | $11.21 | $23.43 | $12.22 | 109.01% |
| 88188 | Flowcytometry/read, 9-15 | 0343 | 0433 | $36.82 | $23.43 | -$13.39 | -36.37% |
| 88189 | Flowcytometry/read, 16 & > | 0343 | 0433 | $36.82 | $23.43 | -$13.39 | -36.37% |
| G0364 | Bone marrow aspirate &biopsy | 0340 | 0340 | $45.50 | $ 49.64 | $4.14 | 9.10% |
TABLE 3 | |||||||
| CPT/ HCPCS | Description | 2012 APC | 2013 APC | 2012 Payment Rate | 2013 Payment Rate | $ Change | % Change |
| 86850 | RBC antibody screen | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86860 | RBC antibody elution | 0346 | 0346 | $24.77 | $24.99 | $0.22 | 0.89% |
| 86870 | RBC antibody identification | 0346 | 0347 | $24.77 | $34.30 | $9.53 | 38.47% |
| 86880 | Coombs test direct | 0409 | 0409 | $7.71 | $9.67 | $1.96 | 25.42% |
| 86885 | Coombs test indirect qual | 0409 | 0409 | $7.71 | $9.67 | $1.96 | 25.42% |
| 86886 | Coombs test indirect titer | 0409 | 0409 | $7.71 | $9.67 | $1.96 | 25.42% |
| 86890 | Autologous blood process | 0347 | 0347 | $47.12 | $34.30 | -$12.82 | -27.21% |
| 86891 | Autologous blood op salvage | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86900 | Blood typing abo | 0409 | 0409 | $7.71 | $9.67 | $1.96 | 25.42% |
| 86901 | Blood typing rh (d) | 0409 | 0409 | $7.71 | $9.67 | $1.96 | 25.42% |
| 86902 | Blood type antigen donor ea | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86904 | Blood typing patient serum | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86905 | Blood typing rbc antigens | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86906 | Blood typing rh phenotype | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86920 | Compatibility test spin | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86921 | Compatibility test incubate | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86922 | Compatibility test antiglob | 0346 | 0346 | $24.77 | $24.99 | $0.22 | 0.89% |
| 86923 | Compatibility test electric | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86927 | Plasma fresh frozen | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86930 | Frozen blood prep | 0347 | 0347 | $47.12 | $34.30 | -$12.82 | -27.21% |
| 86931 | Frozen blood thaw | 0347 | 0347 | $47.12 | $34.30 | -$12.82 | -27.21% |
| 86932 | Frozen blood freeze/thaw | 0347 | 0347 | $47.12 | $34.30 | -$12.82 | -27.21% |
| 86945 | Blood product/irradiation | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86950 | Leukacyte transfusion | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86960 | Vol reduction of blood/prod | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86965 | Pooling blood platelets | 0346 | 0346 | $24.77 | $24.99 | $0.22 | 0.89% |
| 86970 | RBC pretreatment | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86971 | RBC pretreatment | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86972 | RBC pretreatment | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86975 | Rbc pretreatment serum | 0346 | 0347 | $24.77 | $34.30 | $9.53 | 38.47% |
| 86976 | Rbc pretreatment serum | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86977 | Rbc pretreatment serum | 0347 | 0347 | $47.12 | $34.30 | -$12.82 | -27.21% |
| 86978 | Rbc pretreatment serum | 0346 | 0346 | $24.77 | $24.99 | $0.22 | 0.89% |
| 86985 | Split blood or products | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |
| 86999 | Transfusion procedure | 0345 | 0345 | $14.95 | $17.96 | $3.01 | 20.13% |