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Coding & Billing Information for Pathogen-Reduced Platelet and Plasma Products Administered in the Hospital Outpatient Setting

The Centers for Medicare & Medicaid Services (CMS) has established Healthcare Common Procedure Coding System (HCPCS) Level II codes for hospital outpatient billing of INTERCEPT Platelets and Plasma.

HCPCS Code	Long Descriptor	Effective Date
P9070	Plasma, pooled, multiple donor, pathogen reduced, frozen, each unit	1/1/2016
P9071	Plasma (single donor), pathogen reduced, frozen, each unit	1/1/2016
P9073	Platelets, pheresis, pathogen reduced, each unit	1/1/2018

Effective 1/1/2018, HCPCS P9073 replace HCPCS Q9988 to bill pathogen reduced apheresis platelets. HCPCS Q9988 is inactive effective 1/1/2018.

Standard billing practices apply to transfusion procedures used to administer pathogen-reduced, psoralen-treated INTERCEPT platelet and plasma products administered in the outpatient treatment setting.

Standard billing practices apply to INTERCEPT platelet and plasma products administered in the hospital inpatient treatment setting.

References

CY2021 Hospital Outpatient Prospective Payment – Notice of Final Rulemaking with Comment: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1717-FC

The information provided here is for informational purposes only and may be subject to change. Always check with individual third-party payers to verify their requirements for billing these products and associated transfusion services.

Coding and Billing guide for Psoralen-treated platelets and plasma components

Click image to download the guide

WARNINGS AND CONTRAINDICATIONS

CONTRAINDICATIONS: Contraindicated for preparation of platelets or plasma intended for patients with a history of hypersensitivity reaction to amotosalen or other psoralens. Contraindicated for preparation of platelets or plasma intended for neonatal patients treated with phototherapy devices that emit a peak energy wavelength less than 425 nm, or have a lower bound of the emission bandwidth <375 nm, due to the potential for erythema resulting from interaction between ultraviolet light and amotosalen. WARNINGS AND PRECAUTIONS: Only INTERCEPT Processing Sets for platelets or plasma are approved for use in the INTERCEPT Blood System. Use only the INTERCEPT INT100 Illuminator for UVA illumination of amotosalen-treated platelet or plasma components. No other source of UVA light may be used. Please refer to the Operator’s Manual for the INT100 Illuminator. Discard any platelet or plasma components not exposed to the complete INT100 illumination process. Tubing components and container ports of the INTERCEPT Blood System for Platelets contain polyvinyl chloride (PVC). Di(2-ethylhexyl)phthalate (DEHP) is known to be released from PVC medical devices, and increased leaching can occur with extended storage or increased surface area contact. Blood components will be in contact with PVC for a brief period of time (approx. 15 minutes) during processing. The risks associated with DEHP released to into the blood components must be weighed against the benefits of therapeutic transfusion. PLATELETS: Pulmonary events: Acute Respiratory Distress Syndrome (ARDS). INTERCEPT processed platelets may cause the following adverse reaction: Acute Respiratory Distress Syndrome (ARDS). An increased incidence of ARDS was reported in a randomized trial for recipients of INTERCEPT processed platelets, 5/318 (1.6%), compared to recipients of conventional platelet components (0/327). Monitor patients for signs and symptoms of ARDS. PLASMA - Amotosalen-treated plasma may cause the following adverse reaction: Cardiac Events. In a randomized controlled trial of therapeutic plasma exchange (TPE) for TTP, five patients treated with INTERCEPT Blood System processed plasma and none with conventional plasma had adverse events in the cardiac system organ class (SOC) reported. These events included angina pectoris (n=3), cardiac arrest (n=1), bradycardia (n=1), tachycardia (n=1) and sinus arrhythmia (n=1). None of these events resulted in documented myocardial infarction or death. Monitor patients for signs and symptoms of cardiac events during TPE for TTP.