The hospital bills and shows acquisition charges for allogeneic stem cell transplants based
on the status of the patient (i.e., inpatient or outpatient) when the transplant is furnished.
See Pub. 100-04, chapter 4, §231.11 for instructions regarding billing for acquisition
services for allogeneic stem cell transplants that are performed in the outpatient setting.
When the allogeneic stem cell transplant occurs in the inpatient setting, the hospital
identifies stem cell acquisition charges for allogeneic bone marrow/stem cell transplants
separately by using revenue code 0819 (Other Organ Acquisition). Revenue code 0819
charges should include all services required to acquire stem cells from a donor, as defined
above.
On the recipient’s transplant bill, the hospital reports the acquisition charges, cost report
days, and utilization days for the donor’s hospital stay (if applicable) and/or charges for
other encounters in which the stem cells were obtained from the donor. The donor is
covered for medically necessary inpatient hospital days of care or outpatient care provided
in connection with the allogeneic stem cell transplant under Part A. Expenses incurred for
complications are paid only if they are directly and immediately attributable to the stem
cell donation procedure. The hospital reports the acquisition charges on the billing form
for the recipient, as described in the first paragraph of this section. It does not charge the
donor's days of care against the recipient's utilization record. For cost reporting purposes,
it includes the covered donor days and charges as Medicare days and charges.
The transplant hospital keeps an itemized statement that identifies the services furnished,
the charges, the person receiving the service (donor/recipient), and whether this is a
potential transplant donor or recipient. These charges will be reflected in the transplant
hospital's stem cell/bone marrow acquisition cost center. For allogeneic stem cell
acquisition services in cases that do not result in transplant, due to death of the intended
recipient or other causes, hospitals include the costs associated with the acquisition
services on the Medicare cost report.
The hospital shows charges for the transplant itself in revenue center code 0362 or another
appropriate cost center. Selection of the cost center is up to the hospital.
Billing for Autologous Stem Cell Transplants
The hospital bills and shows all charges for autologous stem cell harvesting, processing,
and transplant procedures based on the status of the patient (i.e., inpatient or outpatient)
when the services are furnished. It shows charges for the actual transplant, in revenue
center code 0362 or another appropriate cost center. ICD-9-CM or ICD-10-PCS codes are
used to identify inpatient procedures.
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