Blood Clotting Factors

Section 6011 of Public Law (P.L.) 101-239 amended §1886(a)(4) of the Social Security Act (the Act) to provide that prospective payment system (PPS) hospitals receive an additional payment for the costs of administering blood clotting factor to Medicare hemophiliacs who are hospital inpatients. Under the Inpatient Prospective Payment System (IPPS), hospitals receive a special add-on payment for the costs of furnishing blood clotting factors to Medicare beneficiaries with hemophilia, admitted as inpatients of PPS hospitals. The clotting factor add-on payment is calculated using the number of units (as defined in the HCPCS code long descriptor) billed by the provider under special instructions for units of service.

Medicare outpatient claims are paid based upon the HCPCS code reported and the billed units.

HCPCS Codes eligible for inpatient add-on payment as blood clotting factors (quarterly files).

TRICARE Inpatient Reimbursement for Hemophilia Factors (page 3)