Frequently Asked Questions about Coding, Coverage, and Reimbursement

The American Red Cross has created this list of Frequently Asked Questions (FAQs) about coding, coverage, and reimbursement questions to assist our customers. We hope that this list will answer some of the basic questions that you may have.

1. Is there a guide to the available codes for blood, blood products, and plasma derivatives?

   Yes. We have three primary coding resources. Please see our coding resources posted at http://www.redcross.org/services/biomed/profess/coding.html.

2. The Medicare program has a blood deductible provision that requires that Medicare beneficiaries pay out of pocket or replace the first three units of whole blood or packed red blood cells that they use in a calendar year. How does this provision affect blood supplied by the Red Cross?

   The Medicare program exempts whole blood and red blood cells supplied by the Red Cross from the Medicare blood deductible. This is because the blood and blood products that the American Red Cross supplies hospitals only carry a processing cost and no charge for the supply of the blood product itself. For documentation of this exemption, see the attached citation from the Code of Federal Regulations [Title 42, Section 409.87 (42 CFR § 409.87 -- Blood deductible)].

3. What is the difference between the following two revenue code series: 038x (blood) and 039x (Blood and Blood Component Administration, Processing, and Storage)?

   Revenue code series 038x typically is used for blood and blood products carrying a charge for the products while revenue code series 039x is typically used for blood and blood products from a blood supplier that assesses only a per-unit processing cost but does not charge for the products.

   Hospitals traditionally have billed for blood and blood products under revenue code 0390 for most payers when the products are supplied by a non-profit blood supplier, such as the Red Cross. This is generally used when the charge reflects a processing cost, but not a charge for the blood itself. Some payers alternatively may require use of revenue code 0391 (Administration). Revenue code series 038x would still be used for blood and blood products carrying a charge.

   For more information on this topic, please see our coding resources posted at http://www.redcross.org/services/biomed/profess/coding.html.

4. Does the Red Cross have any restrictions on what a hospital or other provider may charge a payer or patient for a unit of blood or blood product?

   No. It is a hospital's responsibility to determine the appropriate charges for all of the services that it provides, including blood and blood components. The Red Cross has no policies or provisions in its Customer Agreements or contracts that would require a provider to charge in any particular manner.

   If hospitals have specific charging questions, it is advised that hospitals contact their legal and compliance advisors. Healthcare providers should make the ultimate determination as to when to use a specific product based on clinical appropriateness. In addition, providers must determine the most appropriate and proper way in which to code and bill for all products and services that they provide to patients.

5. Is there a way that I can contact the Red Cross with specific questions about coding, coverage, and reimbursement for its products and services?

   Yes. Please contact our Reimbursement Policy and Provider Support department at reimburse@usa.redcross.org. We provide assistance to Red Cross customers of all Red Cross products and services.