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 he has exhausted his
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 his 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, he has the option of replacing
the blood on a pint-for-pint or unit basis, or paying the provider's charges for the
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 his 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 he has replaced,
or arranged to be replaced, on a pint-for-pint or unit basis, each of the blood deductible
pints he 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 him in the future.