(Winston-Salem, N.C.) February 18, 2025 –
The Centers Medicare and Medicaid Services (CMS) has approved the billing of Low Titer O whole blood transfusions as Advanced Life Support, Level 2, which is expected to improve health outcomes of patients and increase financial benefits for urban and rural settings.
While updates to the Medicare Chapter 10 Manual are expected soon, this change is already in effect.
The Medicare Final Rule specifies that LTOWB, Packed Red Blood Cells (PRBC) and Plasma qualify for ALS2 Billing.
Other blood components, such as Cryoprecipitate, Albumin, and similar products are not included in this rule.
They will continue to be billed according to the Scope of Practice.
If the SOP classifies blood product administration as Specialty Care Transport (SCT), EMS|MC will continue to bill these services as SCT per that state’s guidelines.
The ruling will allow agencies to provide more comprehensive care options for critical patients while reducing the financial burden on EMS organizations, especially those which service rural communities where long transportation times and short supplies are common.
EMS|MC partners, PWW|AG, noted in July of 2024 that 1.2 percent of EMS agencies in the United States carry whole blood products, while 200 more systems anticipate the ability to provide some form of blood product.
According to PWW|AG, “CMS believes that many ground ambulance transports providing whole blood transfusion (WBT) during transport already qualify for ALS2 payment since patients requiring such transfusions are generally critically injured or ill and often suffering from cardio-respiratory failure and/or shock, and therefore are likely to receive one or more procedures currently listed as ALS procedures in the definition of ALS2.”
Alone with improving the overall quality of care Daniel P. Burke, the Director of Emergency Medical Services at Center for Patient Safety, noted in an article with JEMS published in November that it “marks a significant gain and a path forward for improved prehospital treatment of hemorrhage.”
He went on to note that it will address hemorrhagic shock and trauma care and will provide quality and equity of care across EMS agencies, along with reducing financial strain on EMS agencies and serving underserved areas.
At this time, no additional funds have been allocated to blood products.
EMS|MC wants you to know that development is underway to ensure CAC can appropriately code this Level of Service.
You should also refer to the Scope of Practice to determine the correct billing level.