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. Section 6011(b) of P.L. 101.239 specified that
the payment be based on a predetermined price per unit of clotting factor multiplied by the
number of units provided. This add-on payment originally was effective for blood clotting
factors furnished on or after June 19, 1990, and before December 19, 1991. Section 13505
of P. L. 103-66 amended §6011 (d) of P.L. 101-239 to extend the period covered by the
add-on payment for blood clotting factors administered to Medicare inpatients with
hemophilia through September 30, 1994. Section 4452 of P.L. 105-33 amended §6011(d)
of P.L. 101-239 to reinstate the add-on payment for the costs of administering bloodclotting
factor to Medicare beneficiaries who have hemophilia and who are hospital
inpatients for discharges occurring on or after October 1, 1998.
A/B MACs (B) shall process non-institutional blood clotting factor claims.
The A/B MACs (A) shall process institutional blood clotting factor claims payable under
either Part A or Part B.
A. - Inpatient Bills
Under the Inpatient Prospective Payment System (IPPS), hospitals receive a special addon
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.
The PPS Pricer software does not calculate the payment amount. The Fiscal Intermediary
Shared System (FISS) calculates the payment amount and subtracts the charges from those
submitted to Pricer so that the clotting factor charges are not included in cost outlier
computations.
