What It Is
Blood transfusions, either for a hospital or skilled nursing facility inpatient, or for an outpatient
Medicare Part A covers blood transfusions for hospital or skilled nursing facility inpatients. Medicare Part B covers blood transfusions for outpatients.
There's no limit on the amount of blood or number of transfusions Medicare will cover.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for blood transfusions, contact the plan directly.
What Medicare Pays
Neither Medicare Part A nor Medicare Part B pays for the first three pints of blood a patient receives, in any setting, during a calendar year.
After the first three pints within a calendar year, the cost of inpatient blood transfusions are part of the total hospital-covered or skilled nursing facility-covered charges paid by Medicare Part A, for which yearly deductible and coinsurance amounts apply.
After the first three pints within a calendar year, Medicare Part B pays 80 percent of the Medicare-approved amount for outpatient blood transfusions.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.