Transfusion, blood or blood components

CPT 36430 is the billing code for "Transfusion, blood or blood components". Transfusion of blood or blood components

Medicare pays approximately $41.73 for CPT 36430 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 36430 has a total RVU of 2.08, broken down as: Work RVU 0.50, Practice Expense RVU 1.50, and Malpractice RVU 0.08. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 36430 include: Type of blood component documented; Volume transfused documented; Patient response to transfusion documented; Vital signs monitored. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 36430: Includes transfusion service. May be billed per unit Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 36430 include: 59 (Distinct procedural service when multiple procedures performed), 91 (Repeat clinical diagnostic laboratory test, same day). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 36430 is Variable based on component and volume. Time-based codes require documentation of the actual time spent providing the service.