Key facts for NCD 110.7
- Benefit category
- Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service
- Effective date
- 12/08/1994
- Implemented 12/08/1994
- Transmittal
- Transmittal 72
- Versions published
- 1
- Manual chapter
- 110
- NCD Manual (Pub. 100-03)
TL;DR
NCD 110.7 sets Medicare's national policy for blood transfusions under the benefit category "Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service", effective 12/08/1994 and implemented 12/08/1994. For Medicare coverage purposes, it is important to distinguish between a transfusion itself and preoperative blood services; e.g., collection, processing, storage. Medically necessary transfusion of blood, regardless of the type, may generally be a covered… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Blood transfusions are used to restore blood volume after hemorrhage, to improve the oxygen carrying capacity of blood in severe anemia, and to combat shock in acute hemolytic anemia.
A. Definitions
1. Homologous Blood Transfusion
Homologous blood transfusion is the infusion of blood or blood components that have been collected from the general public.
2. Autologous Blood Transfusion
An autologous blood transfusion is the precollection and subsequent infusion of a patient's own blood.
3. Donor Directed Blood Transfusion
A donor directed blood transfusion is the infusion of blood or blood components that have been precollected from a specific individual(s) other than the patient and subsequently infused into the specific patient for whom the blood is designated. For example, patient B's brother predeposits his blood for use by patient B during upcoming surgery.
4. Perioperative Blood Salvage
Perioperative blood salvage is the collection and reinfusion of blood lost during and immediately after surgery.
Indications and limitations of coverage
B. Policy Governing Transfusions
For Medicare coverage purposes, it is important to distinguish between a transfusion itself and preoperative blood services; e.g., collection, processing, storage. Medically necessary transfusion of blood, regardless of the type, may generally be a covered service under both Part A and Part B of Medicare. Coverage does not make a distinction between the transfusion of homologous, autologous, or donor-directed blood. With respect to the coverage of the services associated with the preoperative collection, processing, and storage of autologous and donor-directed blood, the following policies apply.
1. Hospital Part A and B Coverage and Payment
Under §1862(a)(14) of the Act, non-physician services furnished to hospital patients are covered and paid for as hospital services. As provided in §1886 of the Act, under the prospective payment system (PPS), the diagnosis related group (DRG) payment to the hospital includes all covered blood and blood processing expenses, whether or not the blood is eventually used.
In a situation where the hospital operates its own blood collection activities, rather than using an independent blood supplier, the costs incurred to collect autologous or donor-directed blood are recorded in the whole blood and packed red blood cells cost center. Because the blood has been replaced, Medicare does not recognize a charge for the blood itself. Under PPS, the DRG payment is intended to pay for all covered blood and blood services, whether or not the blood is eventually used.
Under its provider agreement, a hospital is required to furnish or arrange for all covered services furnished to hospital patients. Medicare payment is made to the hospital, under PPS or cost reimbursement, for covered inpatient and outpatient services, and it is intended to reflect payment for all costs of furnishing those services.
2. Nonhospital Part B Coverage
Under Part B, to be eligible for separate coverage, a service must fit the definition of one of the services authorized by §1832 of the Act. These services are defined in 42 CFR 410.10 and do not include a separate category for a supplier's services associated with blood donation services, either autologous or donor-directed. That is, the collection, processing, and storage of blood for later transfusion into the beneficiary is not recognized as a separate service under Part B. Therefore, there is no avenue through which a blood supplier can receive direct payment under Part B for blood donation services.
C. Perioperative Blood Salvage
When the perioperative blood salvage process is used in surgery on a hospital patient, payment made to the hospital (under PPS or through cost reimbursement) for the procedure in which that process is used is intended to encompass payment for all costs relating to that process.
Text reproduced from the CMS Medicare Coverage Database record for NCD 110.7 version 1. View the original on cms.gov.
Revision history
11/1994 - Clarified coverage and payment policies. Effective date 12/08/1994. (TN 72)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 110.7
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 110.7
What does NCD 110.7 cover?
For Medicare coverage purposes, it is important to distinguish between a transfusion itself and preoperative blood services; e.g., collection, processing, storage. Medically necessary transfusion of blood, regardless of the type, may generally be a covered service under both Part A and Part B of Medicare. Coverage does not make a distinction between the transfusion of homologous, autologous, or donor-directed… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 110.7 take effect?
The current version (1) is effective 12/08/1994, implemented 12/08/1994, published in transmittal 72. This is the only published version.
Does a Local Coverage Determination override NCD 110.7?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.