when the transplants occurred in the inpatient setting. Background The Centers for Medicare & Medicaid Services (CMS) has a coverage policy for stem cell transplantation, and the “Medicare National Coverage Determination (NCD) Manual” (Publication 100-03, Section 110.23) states that stem cell transplantation is a process in See Pub. CR 11729 updates the Medicare Claims Processing Manual, Chapter 3 (Inpatient Hospital Billing, Section 90.3.1 (Allogeneic for Stem Cell Transplantation) and Addendum A (Provider Specific File) to reflect changes in how Medicare will pay for Allogeneic Stem Cell Acquisition 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. It is intended to clarify the billing for stem cell services. Policy: CMS requires the reporting of revenue code 0815 …

In a February 2016 report, the Office of the Inspector General (OIG) determined that Medicare paid for many stem cell transplants incorrectly. The main finding was that providers billed these procedures as inpatient when they should have been submitted as outpatient services. CMS has requested and NUBC approved a new Revenue Code 0815 to be used when the hospital identifies stem cell acquisition charges for allogeneic bone marrow/stem cell transplants separately. B. 100-04, chapter 4, §231.11 for instructions regarding billing for acquisition services for allogeneic stem cell transplants that are

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