Monday, June 21, 2010

Outpatient Prospective Payment System (OPPS) - BL modifier

BL Modifier

Description : Outpatient Prospective Payment System (OPPS) provider purchases blood or blood
products from a community blood bank or when an OPPS provider assesses a charge for blood or blood products collected in its own blood bank that reflects more than blood processing and storage

Required for Claims : Hospital Outpatient Prospective Payment System (OPPS)

Type of Bill: 12X, 13X


Coding Guidelines :
When blood products are purchased, the OPPS provider reports a charge for blood or blood products (Revenue Code 0380), the OPPS provider must also report a charge for processing and storage services on a separate charge line (Revenue Code 0390 nor 0399).

For both the charge lines, the same blood product HCPCS code is applied as well as modifier –BL on BOTH charge lines.

General Guidelines
• This BL modifier should be used ONLY IF:
- An OPPS provider pays for the actual blood or blood product itself from
a community blood bank; or
- An OPPS provider collects the blood or blood product in the OPPS provider’s own blood bank and also assesses a charge for the blood (in addition to paying for processing and storage costs.
• If the OPPS provider does NOT pay for the actual blood or blood product from the community blood bank (i.e. provider is only charged for the processing and storage), the –BL modifier is NOT required
• The –BL modifier is not required for critical access hospitals (CAHs).

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