CurrentUnitedHealthcarePolicy BIP015.O

Blood and blood products coverage

Defines UnitedHealthcare West coverage and prior authorization expectations for blood, blood components, and related services for members; applies to providers billing UnitedHealthcare West plans.

Policy Summary

PayerUnitedHealthcare

PolicyBlood and blood products coverage

Policy CodePolicy BIP015.O

Change TypeRoutine reviewno material change

Effective DateApr 1, 2026

Next Review Date

Key ActionObtain prior authorization for bloodless surgery and other blood products when required by the member's plan.

SourceLink

POLICY UPDATE CHANGES

Routine review; no change to coverage guidelines; archived previous policy version BIP015.N

1policy number identifier

2026-04-01effective date

Coveredcovered when medically necessary

NoneFederal/State regulations

NoneState plan enhancements

Coverage Criteria

Covered Benefits Criteria

Covered when ALL of the following are met:

Medical necessity and plan provisions: Service is medically necessary and consistent with the member's Evidence of Coverage/Schedule of Benefits

If there is a discrepancy between this policy and the member's EOC/SOB, the member's EOC/SOB governs

Covered blood products: Includes use and administration of blood and blood components (cryoprecipitate, platelets, fibrinogen, plasma, gamma globulin, albumin) and blood clotting factors for hemophilia when coverage criteria are met

Applies to blood provided through a blood bank on either an inpatient or outpatient basis

Autologous and donor-directed processing: Autologous and donor-directed blood processing costs covered only for a scheduled procedure, including storage fees charged due to physician/provider cancellations beyond member's control

Policy Summary

PayerUnitedHealthcare

PolicyBlood and blood products coverage

Policy CodePolicy BIP015.O

Change TypeRoutine reviewno material change

Effective DateApr 1, 2026

Next Review Date

Key ActionObtain prior authorization for bloodless surgery and other blood products when required by the member's plan.

SourceLink

On This Page

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Cost of blood collected but not used is covered if the physician authorized the need

Bloodless surgery prior authorization: Bloodless surgery (procedures performed without blood transfusions or blood products, including rho(d) immune globulin) is covered when medically necessary and prior authorization is obtained

Prior authorization may also be required for other blood products as specified by the member's plan

Blood charges associated with procedures that are not authorized or are otherwise non-covered under the member's plan are not covered and may be denied when billed. Providers should confirm authorization and coverage prior to incurring blood-related charges.

All services, including use of blood and blood components, must be medically necessary and consistent with the member's Evidence of Coverage/Schedule of Benefits. If the member's EOC/SOB conflicts with this policy, the EOC/SOB governs; services not medically necessary per the EOC/SOB are not covered.

Coding and Authorization

Covered items (no codes listed)mixedCovered

No codes listed

Prior authorization

Prior authorization requirementPrior authorization is required for bloodless surgery; obtain prior authorization as specified by the member's plan

Plan-level authorizationOther blood products and services may require prior authorization per the member's Evidence of Coverage/Schedule of Benefits

Medical necessity conditionAll services must be medically necessary and consistent with the member's EOC/SOB when prior authorization is obtained

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for bloodless surgery and may be required for other blood products as specified by the member's plan. Obtain prior authorization before scheduling procedures that will be performed without transfusion or that involve blood products to avoid denied services or payment delays.

Bloodless surgery requires prior authorization.
Other blood products may also require prior authorization per the member's plan/EOC/SOB.

Documentation Required

Providers must follow applicable provider-action requirements for documentation, authorization, and billing when furnishing blood, blood components, or performing bloodless surgery. Ensure the treating clinician documents medical necessity and the specific blood products or bloodless approach in the medical record.

Note

Medical Necessity and Member EOC/SOB

Services must be medically necessary and are subject to the member's Evidence of Coverage/Schedule of Benefits. If there is a discrepancy between this policy and the member's EOC/SOB, the EOC/SOB governs. Verify benefits, limitations, and exclusions in the member's plan before rendering services.

Confirm medical necessity for blood products and bloodless procedures.
Verify member-specific coverage, limitations, and exclusions in the EOC/SOB prior to service.

Denial Risk

Non-authorized or Non-covered Procedures — Denial Risk

Blood charges associated with non-authorized or non-covered procedures may not be covered and are at risk of denial. Billers and providers should confirm authorization and coverage status before billing to reduce claim denials.

Unapproved or non-covered procedures involving blood products risk denial of blood-related charges.
Obtain prior authorization and confirm coverage to avoid patient responsibility or denied claims.

Covered Indications

Use and administration of blood and blood components for inpatient or outpatient care when medically necessary.

Indication: Use and administration of blood and blood components for inpatient or outpatient care when medically necessary

Includes cryoprecipitate, platelets, fibrinogen, plasma, gamma globulin, albumin; blood clotting factors for hemophilia when coverage criteria are met

Ordering and coverage determinations: Services must be medically necessary and are subject to the member's Evidence of Coverage/Schedule of Benefits

If EOC/SOB conflicts with policy, EOC/SOB governs; prior authorization required for bloodless surgery and may be required for other products per plan

Exclusions and noncoverage: Blood charges associated with non-authorized or non-covered procedures are not covered

Providers should verify authorization and member benefit provisions to avoid denial of blood-related charges

Definitions

Bloodless Surgery — definition

DefinitionSurgical procedures performed without blood transfusions or blood products, including rho(d) immune globulin

Coverage conditionBloodless surgery is covered when medically necessary and prior authorization is obtained

Examples of excluded productsProcedures omit blood transfusions and blood products (including rho(d) immune globulin)

Ordering Requirements

Billing Rule

Ordering subject to medical necessity and member EOC/SOB

Ordering and coverage of blood and blood products are subject to medical necessity determinations and the member's Evidence of Coverage/Schedule of Benefits; verify plan provisions before ordering.

Refer to the member's EOC/SOB for specific coverage, limitations, and exclusions.
If there is a discrepancy between this policy and the EOC/SOB, the EOC/SOB governs.

Not Covered

NOT COVERED: Blood charges associated with non-authorized or non-covered procedures. Charges for blood products or related services tied to procedures lacking plan authorization or that are excluded by the member's coverage may be denied.

Frequency Limits

Frequency limits

Frequency limits specifiedNot specified in this policy

Refer to EOC/SOBOrdering, coverage, and any applicable limits are subject to the member's Evidence of Coverage/Schedule of Benefits

Medical necessity governs frequencyServices must be medically necessary; frequency determined by clinical need and plan provisions

Background

Blood and blood components — including cryoprecipitate, platelets, fibrinogen, plasma, gamma globulin, albumin, and clotting factors — are used in both inpatient and outpatient settings for diagnosis and treatment. Coverage for these products is contingent on medical necessity and the specific provisions, limitations, and exclusions in the member's Evidence of Coverage/Schedule of Benefits. If there is a discrepancy between this policy and the member's EOC/SOB, the member's EOC/SOB provision will govern.