2023 HCPCS	2023 Short Description	2023 Days	2023 Units	2023 Total Cost	2023 Minimum Unit Cost	2023 Maximum Unit Cost	2023 Arithmetic Mean Unit Cost	2023 Geometric Mean Unit Cost	2023 Geometric Mean Day Cost	2023 Median Unit Cost	2023 Median Day Cost	2023 CV (%) of Unit Cost	Proposed CY 2025 XRef HCPCS/CPT Code(s)	Proposed CY 2025 XRef SI	Proposed CY 2025  XRef APC	Proposed CY 2025 Payment Rate	
C9507	Covid-19 convalescent plasma	5	6	"2,751.36"	458.56	458.56	458.56	458.56	526.75	458.56	458.56	0.000	C9507	R	9540	$443.51	
P9010	Whole blood for transfusion	152	222	"62,766.82"	22.88	"1,589.25"	282.73	235.62	301.52	247.10	312.90	75.329	P9010	R	9510	$227.89	
P9011	Blood split unit	500	606	"133,478.37"	10.25	"1,098.72"	220.26	148.02	181.45	117.25	176.12	115.446	P9011	R	9520	$143.16	
P9012	Cryoprecipitate each unit	445	3175	"247,249.92"	8.34	678.51	77.87	64.05	373.75	55.45	504.59	194.145	P9012	R	9511	$61.94	
P9016	Rbc leukocytes reduced	192020	273315	"60,821,578.24"	19.01	"1,785.28"	222.53	187.77	252.14	200.29	257.14	72.757	P9016	R	9512	$181.60	
P9017	Plasma 1 donor frz w/in 8 hr	1766	5285	"558,736.40"	4.26	737.87	105.72	88.61	191.81	89.28	187.69	125.037	P9017	R	9508	$85.70	
P9019	"Platelets, each unit"	162	557	"53,636.99"	30.42	694.08	96.30	73.09	199.97	56.87	284.36	228.557	P9019	R	9515	$70.70	
P9021	Red blood cells unit	4357	6476	"1,228,729.48"	14.98	"1,369.18"	189.74	145.80	199.20	122.74	213.13	91.354	P9021	R	9517	$141.02	
P9022	Washed red blood cells unit	444	1143	"494,226.36"	67.73	973.77	432.39	388.22	724.01	438.39	709.57	71.804	P9022	R	9518	$375.47	
P9023	"Frozen plasma, pooled, sd"	109	687	"42,840.80"	32.46	225.52	62.36	56.46	324.40	47.02	282.09	121.159	P9023	R	9509	$54.60	
P9025	Plasma cryo redu path each	5	5	729.25	145.85	145.85	145.85	145.85	145.85	145.85	145.85	0.000	P9025	R	9538	$141.06	
P9026	Cryo fib comp path redu each	7	21	"9,920.49"	130.88	802.38	472.40	333.38	"1,350.38"	587.89	"1,604.75"	130.163	P9026	R	9539	$322.44	
P9031	Platelets leukocytes reduced	258	809	"121,953.89"	24.87	875.85	150.75	130.90	331.76	136.37	315.88	117.005	P9031	R	9526	$126.60	
P9032	"Platelets, irradiated"	831	4024	"556,933.55"	137.90	142.65	138.40	138.40	667.39	137.90	689.48	2.216	P9032	R	9500	$133.86	
P9033	Platelets leukoreduced irrad	1448	4179	"1,279,087.35"	35.00	"1,887.44"	306.07	216.62	710.81	152.39	713.25	182.017	P9033	R	9521	$209.51	
P9034	"Platelets, pheresis"	859	1026	"569,619.88"	22.78	"2,805.57"	555.19	406.98	480.48	513.16	614.74	70.729	P9034	R	9507	$393.62	
P9035	Platelet pheres leukoreduced	17014	20392	"12,321,302.47"	53.62	"3,415.75"	604.22	501.72	577.35	547.38	612.59	69.027	P9035	R	9501	$485.25	
P9036	Platelet pheresis irradiated	479	479	"336,965.11"	131.72	"1,621.37"	703.48	591.22	591.22	479.99	479.99	56.653	P9036	R	9502	$571.82	
P9037	Plate pheres leukoredu irrad	27417	30490	"24,971,334.52"	93.62	"4,154.38"	819.00	695.51	757.62	728.47	728.47	59.416	P9037	R	9530	$672.68	
P9038	Rbc irradiated	1054	1407	"266,761.90"	54.84	"1,504.09"	189.60	152.36	203.76	150.74	222.05	73.403	P9038	R	9505	$147.36	
P9039	Rbc deglycerolized	7	8	"9,236.18"	146.80	"3,609.20"	"1,154.52"	742.68	745.16	960.40	584.41	105.745	P9039	R	9504	$718.29	
P9040	Rbc leukoreduced irradiated	107278	135599	33693116.2	26.61	1643.16	248.48	212.39	256.48	214.24	251.25	70.027	P9040	R	9522	$250.990	
P9041	"Albumin (human),5%, 50ml"	22	110	"4,844.40"	44.04	44.04	44.04	44.04	220.22	44.04	220.22	0.000	P9041	N			
P9044	Cryoprecipitatereducedplasma	101	356	53879.99	8.68	305.28	151.35	131.51	214.91	189.01	201.43	71.042	P9044	R	9523	$68.740	
P9047	"Albumin (human), 25%, 50ml"	37	142	"14,059.53"	69.08	184.89	99.01	91.93	341.27	78.47	376.15	85.505	P9047	N			
P9048	"Plasmaprotein fract,5%,250ml"	11	19	"2,601.81"	35.54	159.54	136.94	126.31	184.90	159.54	319.08	41.376	P9048	R	9519	$122.15	
P9051	"Blood, l/r, cmv-neg"	352	491	"106,825.12"	26.73	884.48	217.57	188.54	250.45	193.12	229.34	68.373	P9051	R	9524	$182.35	
P9052	"Platelets, hla-m, l/r, unit"	949	1111	"984,838.86"	215.27	"3,001.79"	886.44	804.64	916.20	804.68	822.85	51.277	P9052	R	9525	$778.23	
P9053	"Plt, pher, l/r cmv-neg, irr"	434	521	"281,409.55"	129.31	"1,159.02"	540.13	467.24	547.59	485.76	567.29	56.238	P9053	R	9531	$451.90	
P9054	"Blood, l/r, froz/degly/wash"	58	86	"25,154.04"	118.57	807.11	292.49	245.89	366.07	181.81	363.62	79.693	P9054	R	9527	$237.81	
P9055	"Plt, aph/pher, l/r, cmv-neg"	103	143	"36,533.16"	117.41	732.09	255.48	244.78	323.67	240.96	262.09	40.179	P9055	R	9528	$236.75	
P9056	"Blood, l/r, irradiated"	440	674	"71,117.84"	38.08	551.38	105.52	88.74	129.65	93.73	162.77	100.006	P9056	R	9529	$85.82	
P9057	"Rbc, frz/deg/wsh, l/r, irrad"	106	181	"98,421.04"	163.13	915.48	543.76	518.58	785.86	555.26	941.54	35.134	P9057	R	9532	$501.56	
P9058	"Rbc, l/r, cmv-neg, irrad"	1287	1755	"479,513.45"	41.24	880.34	273.23	224.80	298.98	219.03	291.35	83.874	P9058	R	9533	$217.42	
P9059	"Plasma, frz between 8-24hour"	1736	5201	"436,361.97"	3.27	"1,643.65"	83.90	70.37	142.45	78.13	133.52	133.590	P9059	R	9513	$68.05	
P9060	Fr frz plasma donor retested	3	4	190.33	39.88	50.15	47.58	47.36	58.54	50.15	50.15	13.217	P9060	R	9503	$45.81	
P9070	Pathogen reduced plasma pool	2	2	116.91	51.94	64.97	58.46	58.09	58.09	58.46	58.46	15.762	P9070	R	9534	$56.18	
P9071	Pathogen reduced plasma sing	12	12	"4,226.95"	64.97	598.67	352.25	282.52	282.52	314.97	314.97	55.341	P9071	R	9535	$273.25	
P9073	Platelets pheresis path redu	39178	44460	"31,361,789.22"	77.06	"3,215.87"	705.39	589.55	651.65	635.30	685.36	64.235	P9073	R	9536	$570.19	
																	
																	
																	
																	
																	
