This section outlines the payment policy and claims filing instructions for blood transfusions and related services.
Introduction
Payment Policy
Payment for blood transfusion services is HMSA's eligible charge less any member copayment and/or deductible.
HMSA's payment for blood transfusion services is an all-inclusive rate that includes, but is not limited to, transfusion medicine services, professional services (including nonphysician services), use of the treatment and/or recovery room, associated medical/surgical supplies, and routine and oral pharmacy items.
Note: The all-inclusive rate can be billed for each day that an HMSA member receives blood transfusion services.
Coding
Using the correct combination of codes is the key to minimizing delays in claims processing. Please ensure that revenue codes and procedure codes reflect the diagnoses and services rendered. Third-digit subcategories for the revenue code are included in the UB-04 manual.
Commonly Billed Services
The matrix below depicts commonly billed services and acceptable code ranges that correspond to HMSA's claims processing requirements for blood transfusion services. The matrix represents a range of possible combinations and should not be viewed as comprehensive.
Administration
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 0391 | Blood administration (e.g., transfusion) | CPT | 36430 | Transfusion, blood or blood components |
| 71x | Recovery room | |||
| 76x | Specialty room - Treatment/observation room | Although recommended by Medicare's ambulatory payment classification (APC), this code is part of HMSA's all-inclusive rate and is not paid separately |
Incidental Drugs and Supplies
Incidental drugs and supplies are used to deliver the service. These items are included in the administration fee and are not reimbursed separately.
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 25x | Pharmacy | HCPCS | Use HCPCS codes that describe the services rendered. | |
| 27x | Medical/surgical supplies and devices | HCPCS | Use HCPCS codes that describe the services rendered. | |
| 30x | Laboratory | CPT | 86850 - 86999 | Immunology and transfusion medicine services such as antibody screens, blood typing and blood preparation. |
Blood Products Requiring Specific Identification
Blood products requiring specific identification must be billed separately.
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 390 | Administration, processing and storage for blood and blood components: general | HCPCS | P9010 | Blood (whole), for transfusion, per unit |
| P9011 | Blood, split unit (specify amount) | |||
| P9012 | Cryoprecipitate, each unit | |||
| P9016 | Red blood cells, leukocytes reduced, each unit | |||
| P9017 | Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit | |||
| P9019 | Platelets, each unit | |||
| P9020 | Platelet rich plasma, each unit | |||
| P9021 | Red blood cells, each unit | |||
| P9022 | Red blood cells, washed, each unit | |||
| P9023 | Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit | |||
| P9031 -P9040 | Consult HCPCS manual for individual descriptions | |||
| P9044 | Plasma, cryoprecipitate reduced, each unit |
UB-04 Highlights: Sample Claim
See Blood Transfusion Services - UB-04 Highlights [PDF] for a sample of the claim explained below.
Note: It may be helpful to print the sample claim, then return to this page.
Explanation of Sample Claim
| Form Identifier | Form Locator | Explanation |
|---|---|---|
| 1 | 4 | Type of bill 131 indicates the type of facility is a hospital (1), the bill classification is outpatient (3) and the frequency is admit through discharge (1). |
| 2 | 44 | 391R must be used in conjunction with revenue code 391. Other procedure codes in form locator 44 coincide with appropriate revenue codes. |
| 3 | 45 | Each day of treatment is listed on a separate line. The administration of the drug and the drug itself must be billed on the same day. |
| 4 | 46 | Only one unit is billed per administration code. Blood products and drugs are billed with multiple units, as necessary. |
| 5 | 67 | All drugs and services on the claim must be appropriate for the principal diagnosis code listed in form locator 67. |
Notes:
- Locator 46: Refer to Service Units for more information.
- Locator 67: For more information on the principal diagnosis code, refer to Diagnosis Coding for Principal Diagnosis, Diagnosis Coding for Secondary Diagnosis.
Billing Tips
Blood Transfusion in an Emergency Room
CPT code 36430 (transfusion, blood or blood components) may be billed as a separate line item when the service is performed in conjunction with an emergency room visit.
Laboratory Services
Laboratory services for blood transfusion are considered part of the all-inclusive rate. This holds true even if the blood work is done the day before the actual transfusion.
Treatment Room
Any treatment and/or recovery room used in conjunction with blood transfusion services is part of the all-inclusive rate and should not be billed separately.
Other Services
The following services are not included in the all-inclusive rate for blood transfusions and must be billed separately: chemotherapy, laboratory/pathology, radiology, radiotherapy, diagnostic tests and patient convenience items.
Service Units
Blood transfusion services (as well as injectable drugs and other therapeutic services) must be billed as one unit. The number of units in form locator 46 should never be greater than one per line item when billing revenue code 391.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |