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, blood processing and storage, 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 and Blood Products Requiring Specific Identification
Blood and blood products requiring specific identification must be billed separately. Refer to Payment Policies – Enhanced Code Editing for additional billing guidance under Blood and Blood Product Charges.
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 0380 - 0389 | Blood and blood products | HCPCS | P90XX | Blood – Use HCPCS codes that describe the services rendered |
Blood Processing and Storage
Refer to Payment Policies – Enhanced Code Editing for additional billing guidance under Blood Processing and Storage Charges.
| Revenue Code | Description | Level of Code | Code | Description |
|---|---|---|---|---|
| 0390 - 0399 | Blood storage and processing | HCPCS | P90XX | Blood – Use HCPCS codes that describe the services rendered |
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 |
|---|---|
| 10/01/2026 |
|
| 09/28/2026 | Migrated to new platform. |