The blood deductible applies only to whole blood and packed red cells. The term whole blood means human blood from which none of the liquid or cellular components have been removed. Where packed red cells are furnished, a unit of packed red cells is considered equivalent to a pint of whole blood. Other components of blood such as platelets, fibrinogen, plasma, gamma globlin, and serum albumin are not subject to the blood deductible. However, these components of blood are covered as biologicals.

Program payment may not be made for the first three pints of whole blood or equivalent units of packed red cells received by a beneficiary in a benefit period. However, payment may be made for blood processing beginning with the first pint or unit in a benefit period. The blood deductible is in addition to any other applicable deductible and coinsurance amounts for which the patient is responsible.

To be covered a Part A service and count toward the blood deductible, the blood must be furnished on a day which counts as a day of inpatient hospital services or extended care services. Thus, blood is not covered under Part A and does not count toward the Part A blood deductible when furnished to an inpatient after they have exhausted their benefit days in a benefit period, or where the individual has elected not to use lifetime reserve days. However, where the patient is discharged on their first day of entitlement, the provider is permitted to submit a billing form with no accommodation charge, but with ancillary charges including blood.

When the beneficiary is subject to the blood deductible, they have the option of replacing the blood on a pint-for-pint or unit basis, or paying the provider's charges for the unreplaced pints.

When a beneficiary elects to replace deductible pints or units, it is considered replaced if the patient or someone else, e.g., a volunteer blood bank organization, replaces the blood on their behalf. For Medicare purposes, replacement is made on a pint-for-pint or unit basis. Although a provider is free to persuade a beneficiary to arrange for donation of more blood than was required to meet the deductible provisions, no charge may be made to a beneficiary who does not comply with the request if they have replaced, or arranged to be replaced, on a pint-for-pint or unit basis, each of the blood deductible pints they received.

Where more blood is donated on behalf of the beneficiary than is needed for full replacement on a pint-for-pint or unit basis, the value of the excess blood is not deducted from the amount payable to the provider. However, such donations would tend to reduce the cost of blood to the provider. Where a provider accepts blood donated in advance for or by a beneficiary in anticipation of need, such donations are considered as replacement for any deductible pints or units subsequently furnished to the beneficiary in the future.

A beneficiary who receives blood (or packed red cells) which is subject to the blood deductible, has the option of arranging to replace the blood or paying the provider's charges for the unreplaced pints.

Extended care services covered under Part A include unreplaced blood (after satisfaction of the three pint blood deductible) and processing costs beginning with the first pint. However, blood transfusions are ordinarily performed by hospitals and not by SNF's. Thus, in the usual case, where an SNF patient needs blood, a participating hospital provides the blood and the laboratory services and performs the transfusion under arrangements with the SNF. In such a case, the hospital's charge for such blood and services is a blood cost and/or a blood processing cost to the SNF.

NOTE: Ambulance transportation of the patient between the hospital and SNF for the purpose of obtaining a blood transfusion is covered under Part B if the conditions for coverage of ambulance services are met.