CurrentUnitedHealthcarePolicy 2025R6012A

UB04 Outpatient Blood and Blood Product Billing/Reimbursement

Defines UnitedHealthcare's reimbursement rules for outpatient facility (UB04/ASC/OSC) claims for transfusion, freezing/thawing, irradiation, and splitting of blood or blood products for UnitedHealthcare Commercial and Individual Exchange plans.

Policy Summary

PayerUnitedHealthcare

PolicyUB04 Outpatient Blood and Blood Product Billing/Reimbursement

Policy CodePolicy 2025R6012A

Change TypeAdministrative code list update

Effective Date

Next Review Date

Key ActionSubmit the appropriate HCPCS code on the same claim line whenever a revenue code for a blood or blood product is submitted.

SourceLink

POLICY UPDATE CHANGES

Packed Red Cells Code List was updated.

UB04/ASC/OSCclaim forms / settings

36430-36460transfusion codes

0391required revenue code

P9011split unit HCPCS

86945 ruleirradiation billing rule

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Billing and Coverage Criteria for Blood and Blood Products

Billing/Coding Criteria

Billing and coding requirements for blood and blood product services:

When a revenue code is submitted for a blood or blood product, the appropriate HCPCS code must also be submitted on the same claim line.

Transfusion services (CPT codes 36430-36460) should be reported with revenue code 0391; a single transfusion CPT is submitted once per service regardless of the number of units transfused, and the applicable blood/blood product HCPCS code must be submitted on the same claim line.

Irradiation (CPT 86945) should not be separately reported in addition to a HCPCS code that includes the irradiated blood or blood product; report 86945 only when a specific irradiated HCPCS code does not exist.

When freezing or thawing services are provided, submit the HCPCS code that includes both the freezing/thawing service and the blood or blood product when available; do not separately bill freezing/thawing CPT codes in addition to a bundled HCPCS.

For split units: submit HCPCS P9011 with the appropriate revenue code (0383, 0384, or 0389) that identifies the blood or blood product; report CPT 86985 for each splitting procedure performed to prepare product for a specific patient and only when that service was performed for the patient receiving the transfusion.

Report packed red blood cells under revenue code 0381 and whole blood under revenue code 0382; claims may be denied if a HCPCS code is not submitted with the corresponding revenue code or if the HCPCS does not represent the product matching the revenue code.

CPT/HCPCS/Revenue Codes and Submission Rules

Transfusion CPT Codes (report once per service)CPTCovered

36430	Transfusion, venous catheter or peripheral transfusion (see mapping to 36440/36450/36455/36456/36460)
36440	Transfusion, packed red blood cells (mapping: 36430,1 = 36440)
36450	Transfusion, fresh frozen plasma (mapping: 36430,2 = 36450)
36455	Transfusion, platelets (mapping: 36430,3 = 36455)
36456	Transfusion, granulocytes (mapping: 36430,4 = 36456)
36460	Transfusion, other blood product (mapping: 36430,5 = 36460)

IrradiationCPTCovered

86945

Irradiation of blood or blood product — only report when a specific HCPCS code for irradiated product does not exist; do not report in addition to a HCPCS code that includes irradiation

Freezing and Thawing CodesCPTCovered

86927	Freezing/thawing service
86930	Freezing/thawing service
86931	Freezing/thawing service
86932	Freezing/thawing service

Split Unit / Splitting ProceduremixedCovered

P9011	Blood, split unit — submit with appropriate revenue code (0383, 0384, or 0389) identifying the blood or blood product transfused
86985	Blood or blood product splitting — submit for each splitting procedure performed to prepare the product for a specific patient

Packed Red Cells and Whole Blood HCPCS CodesHCPCSCovered

P9016	Packed red blood cells
P9021	Packed red blood cells
P9022	Packed red blood cells
P9027	Packed red blood cells
P9038	Packed red blood cells
P9039	Packed red blood cells
P9040	Packed red blood cells
P9051	Packed red blood cells / Whole blood (listed in both packed red cells and whole blood lists)
P9054	Packed red blood cells / Whole blood (listed in both packed red cells and whole blood lists)
P9057	Packed red blood cells

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Billing/Submission Rulesmixed

Revenue 0391	Transfusion services (report transfusion CPTs 36430-36460 with revenue code 0391)
Revenue 0381	Packed red blood cells — submit HCPCS with revenue code 0381 or may be denied
Revenue 0382	Whole blood — submit HCPCS with revenue code 0382 or may be denied
Rule	Submit a single transfusion CPT once per service regardless of number of units; also submit the applicable HCPCS code(s) for the blood or blood product on the same claim

Billing Requirements and Provider Responsibilities

Billing Rule

Submit HCPCS with revenue code on same claim line

When submitting a revenue code for any blood or blood product, also submit the appropriate HCPCS code on the same claim line. For transfusion services (CPT 36430-36460), report revenue code 0391 and include the applicable blood/blood product HCPCS code on that same line.

Apply this requirement to all UB04/ASC/OSC outpatient claims that report blood or blood products.
Submit a single transfusion CPT (36430-36460) once per service and include the matching HCPCS product code on the same line.

Key Definitions

inv-09: split unit

DefinitionA split unit of blood or blood product is where portions are given to different patients or the same patient at different times.

HCPCS reportingHCPCS code P9011 must be submitted to identify a split unit on the claim.

Revenue code mappingSubmit P9011 with the appropriate revenue code that identifies the blood/product (0383, 0384, or 0389).

Splitting procedure CPTCPT 86985 should be submitted for each splitting procedure performed to prepare the blood product for a specific patient; do not report splitting unless performed for the patient receiving the transfusion.

inv-10: single transfusion submission

DefinitionSingle transfusion submission: submit one transfusion CPT code (from 36430-36460) once per service regardless of the number of units transfused.