HLA match Fee

[wcarter]

HI,

I am new to this site and was wondering if I could get some help regarding HLA match fee for plts.

We currently get receive our blood from UBS. They have billed us and HLA match fee for $204 per unit of plts. (4 total so far). We have a patient here that is getting HLA matched plts. 2-3 times per week. I am wondering if there is a CPT code or some other code that we can list and pass this fee to her insurance company.

Thanks alot for any help that anyone may have.

Wendy Carter

Pembina County Memorial Hospital

Cavalier, ND

[THintz]

Wendy,

For this product we bill the HCPCS Level II code P9052 which is platelet apheresis, leukocyte reduced, HLA matched. We make sure the charge to the patient for this code covers all associated expenses (the product plus any extra fees associated with it).

One question I've always had about P9052 is that the description of it does not mention "irradiated". So, I wonder--In addition does anyone charge a separate CPT code for irradiation (CPT 86945), or do you consider this "built in" to P9052 as it is assumed that all HLA matched products require irradiation.--Thanks.

[Seveets]

We also have a HLA matching charge using code # P9052.

We have this as an additional charge added to the platelet charge (if someone remembers).

For irradiation charges we have that built in to the cost of the product.

for irradiated PC we use P9040

for irradiated PLTs we use P9037

[bmarotto]

We also use P9052. We assume the irradiation is built in similar to the thawing charge being included in thawed products. I believe P9052 includes the charge for the HLA matching and the leukoreduced apheresis platelet product itself. We do not charge P9037 in addition to P9052.

[Trek Tech]

We charge the P9052 for the HLA-leukoreduced platelet pheresis. Our facility does the irradiation so we charge 86945 to cover the irradiation of the unit. I believe you can only charge for the irradiation if your facility performs it. I could be wrong.

[bbbirder]

Here is a link to a CMS web page that is very helpful...(if there is a more recent version, sorry I don't have it bookmarked)

http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf

Search the document for what you need or start at section 231 related to blood products.

Here is what it says about irradiation:

231.5 - Billing for Irradiation of Blood Products

(Rev. 496, Issued: 03-04-05, Effective: 07-01-05, Implementation: 07-05-05)

In situations where a beneficiary receives a medically reasonable and necessary

transfusion of an irradiated blood product, an OPPS provider may bill the specific

HCPCS code which describes the irradiated product, if a specific code exists, in addition to the CPT code for the transfusion. If a specific HCPCS code for the irradiated blood product does not exist, then the OPPS provider should bill the appropriate HCPCS code for the blood product, along with CPT code 86945 (irradiation of blood product, each unit).

Linda Frederick

[NANCY F]

What should we do regarding billing for HLA plt pheresis, when it was ordered in for a patient who did not end up using it? I have sometimes given these pheresis to patients who do not need HLA match or irrad, so that the product is not wasted. However, so far we've just ended up eating the charges on the HLA match and irradiation fees.

Thanks for any suggestions

Nancy F