2022 HCPCS	2022 Short Description	2022 Days	2022 Units	2022 Total Cost	2022 Minimum Unit Cost	2022 Maximum Unit Cost	2022 Arithmetic Mean Unit Cost	2022 Geometric Mean Unit Cost	2022 Geometric Mean Day Cost	2022 Median Unit Cost	2022 Median Day Cost	2022 CV (%) of Unit Cost	Proposed CY 2024 XRef HCPCS/CPT Code(s)	Proposed CY 2024 XRef SI	Proposed CY 2024  XRef APC	Proposed CY 2024 Payment Rate
C9507	Covid-19 convalescent plasma	6	6	3198.51	86.52	1277.71	533.09	411.97	411.97	458.57	458.57	73.905	C9507	R	9540	$411.97
P9010	Whole blood for transfusion	104	146	34531.54	29.14	611.39	236.52	203.74	256.09	203.36	208.54	61.978	P9010	R	9510	$203.74
P9011	Blood split unit	678	821	165319.07	25.25	858.21	201.36	151.99	177.21	153.83	177.17	95.59	P9011	R	9520	$151.99
P9012	Cryoprecipitate each unit	394	2769	222917.01	6.37	556.58	80.5	68.5	384.59	68.36	500.26	167.937	P9012	R	9511	$68.50
P9016	Rbc leukocytes reduced	202811	292742	62774934.89	19.96	1618.96	214.44	183.82	250.6	195.5	253	68.05	P9016	R	9512	$183.82
P9017	Plasma 1 donor frz w/in 8 hr	1874	5896	512548.92	3.53	696.45	86.93	67.07	157.61	75.26	161.42	148.574	P9017	R	9508	$67.07
P9019	"Platelets, each unit"	308	1288	95651.73	34.37	695.64	74.26	63.78	245.53	55.9	279.51	207.192	P9019	R	9515	$63.78
P9020	Plaelet rich plasma unit	11	11	5941.43	540.13	540.13	540.13	540.13	540.13	540.13	540.13	0	P9020	R	9516	$540.13
P9021	Red blood cells unit	4312	6638	1161489.37	14.7	1247.56	174.98	134.53	189.64	109.55	165.98	106.966	P9021	R	9517	$134.53
P9022	Washed red blood cells unit	468	1105	568667.26	20.03	1712.1	514.63	387.03	631.35	446.85	612.96	115.311	P9022	R	9518	$387.03
P9023	"Frozen plasma, pooled, sd"	83	457	31126.21	31.57	240.47	68.11	62.5	269.6	72.51	329.01	113.797	P9023	R	9509	$62.50
P9031	Platelets leukocytes reduced	372	1069	161594.09	16.44	1340	151.16	126.05	301.4	124.06	394.22	139.386	P9031	R	9526	$126.05
P9032	"Platelets, irradiated"	1051	4979	703985.46	125.09	157.42	141.39	141.36	665.97	139.08	695.42	4.568	P9032	R	9500	$141.36
P9033	Platelets leukoreduced irrad	1406	4368	1315435.39	7.98	1123.9	301.15	232.74	707.08	359.45	694.35	121.399	P9033	R	9521	$232.74
P9034	"Platelets, pheresis"	1143	1370	599611.27	23.61	3544.27	437.67	319.83	366.67	454.15	513.32	76.532	P9034	R	9507	$319.83
P9035	Platelet pheres leukoreduced	17825	21251	12163141.13	58.17	3094.09	572.36	480.33	550.16	514.79	568.14	68.742	P9035	R	9501	$480.33
P9036	Platelet pheresis irradiated	685	754	473338.64	162.82	1970.75	627.77	572.3	616.16	526.24	526.24	45.916	P9036	R	9502	$572.30
P9037	Plate pheres leukoredu irrad	26695	29754	22842583.01	91.2	3713.76	767.71	671.71	737.47	729.43	741.11	52.767	P9037	R	9530	$671.71
P9038	Rbc irradiated	883	1196	346650.9	63.06	582.21	289.84	218.16	293.74	234.07	299.77	79.534	P9038	R	9505	$218.16
P9039	Rbc deglycerolized	11	14	7179.88	44.4	1130.66	512.85	296.86	386.37	229.59	459.17	101.3	P9039	R	9504	$296.86
P9040	Rbc leukoreduced irradiated	100417	129366	37550251.76	36.84	1645.4	290.26	257.5	314.45	256.59	312.86	58.565	P9040	R	9522	$257.50
P9044	Cryoprecipitatereducedplasma	84	229	20497.66	15.99	301.78	89.51	69.83	119.52	56.96	80.89	125.956	P9044	R	9523	$69.83
P9048	"Plasmaprotein fract,5%,250ml"	2	2	180.04	34.17	145.87	90.02	70.6	70.6	90.02	90.02	87.74	P9048	R	9519	$70.60
P9051	"Blood, l/r, cmv-neg"	364	510	102939.36	25.58	932.3	201.84	172.46	235.18	174.53	233.95	75.961	P9051	R	9524	$172.46
P9052	"Platelets, hla-m, l/r, unit"	743	834	738617.2	122.99	3882.87	885.63	761.05	840.48	769.29	925.91	65.385	P9052	R	9525	$761.05
P9053	"Plt, pher, l/r cmv-neg, irr"	395	524	294774.88	153.96	1674.61	562.55	529.33	668.93	570.49	638.7	40.386	P9053	R	9531	$529.33
P9054	"Blood, l/r, froz/degly/wash"	75	107	26106.62	128.08	633.74	243.99	224.89	314.41	194.41	388.81	60.355	P9054	R	9527	$224.89
P9055	"Plt, aph/pher, l/r, cmv-neg"	85	104	27111.2	141.62	670.03	260.68	244.71	289.33	213.38	283.23	46.838	P9055	R	9528	$244.71
P9056	"Blood, l/r, irradiated"	372	526	56588.31	44.92	493.1	107.58	88.96	121.33	80.09	147.47	95.172	P9056	R	9529	$88.96
P9057	"Rbc, frz/deg/wsh, l/r, irrad"	107	186	77091.66	162.68	722.41	414.47	379.2	579.13	489.88	746	47.983	P9057	R	9532	$379.20
P9058	"Rbc, l/r, cmv-neg, irrad"	1265	1668	512934.2	38.71	948.31	307.51	249.11	330.55	256.7	299.36	81.079	P9058	R	9533	$249.11
P9059	"Plasma, frz between 8-24hour"	1841	4829	426659.76	3.93	755.11	88.35	74.81	142.51	84.75	133.26	100.129	P9059	R	9513	$74.81
P9060	Fr frz plasma donor retested	8	11	697.61	40.57	113	63.42	59.76	75.83	60.33	60.33	48.047	P9060	R	9503	$59.76
P9070	Pathogen reduced plasma pool	1	2	65.9	32.95	32.95	32.95	32.95	65.89	32.95	65.89	.	P9070	R	9534	$32.95
P9071	Pathogen reduced plasma sing	6	6	1575	133.85	288.23	262.5	253.64	253.64	288.23	288.23	24.01	P9071	R	9535	$253.64
P9073	Platelets pheresis path redu	38059	42809	28283252.97	64.87	2473.98	660.68	566.13	619.61	607.61	655.72	56.594	P9073	R	9536	$566.13
P9099	Blood component/product noc	622	622	202307.54	155.93	536.07	325.25	318.19	318.19	312.39	312.39	22.705	P9099	R	9537	$32.95
