In UB‑04 institutional billing, value code 38 marks the number of deductible blood pints not replaced by a patient. Proper reporting in 2025 ensures compliance with Medicare Part A rules and avoids claim adjustments.
What Is value code 38?
This code represents unreplaced pints of whole blood or packed red cells furnished within a calendar year. If all deductible units are replaced or donated, no entry is recorded for this value code.:contentReference[oaicite:2]{index=2}
2025 Policy Updates
Medicare adjusted broader outpatient billing guidelines under OPPS, CPT, and HCPCS in 2025, but no changes directly affect the mechanics of value code 38.:contentReference[oaicite:3]{index=3}
Deductible Rule Remains
As in previous years, Medicare won’t pay for the first three pints served per beneficiary annually. A provider may report up to three unreplaced units via this blood deductible code—strictly for units not replaced.:contentReference[oaicite:4]{index=4}
Using value code 38 in Claims
Enter the code in UB‑04 Form Locators 39–41 under Value Codes. Place the number of unreplaced deductible pints in the amount field. Always list codes in ascending alphanumeric order and never report more than three pints per year per beneficiary.:contentReference[oaicite:5]{index=5}
Best Practices for Billing
- Verify replacement status. If the patient or donor replaced the units, omit this deductible code.
- Limit deductible units to three per year per beneficiary.
- Ensure consistency between total pints (value code 37), deductible pints (value code 38), and revenue codes such as 0381 or 0382.:contentReference[oaicite:6]{index=6}
- Document all replacement arrangements clearly for audit support.
- Use transition words like “Conversely,” “Additionally,” and “For example” to enhance readability.:contentReference[oaicite:7]{index=7}
Example Use Case
For example, a beneficiary receives two packed red cell units and does not replace them:
- Revenue code 0381 indicates transfused units.
- Value code 37 = “2” total pints supplied.
- Value code 38 = “2” deductible pints reported.
Conversely, if the patient or donor replaces these units, the deductible code must be omitted entirely.
FAQs: value code 38
Can value code 38 be reported if blood is donated or replaced?
No. If replacement covers all deductible units, there is no deductible responsibility and this code should not be used.:contentReference[oaicite:8]{index=8}
Where do I enter value code 38 on the UB‑04?
It belongs in Form Locators 39–41 under Value Codes and should be adjacent to the number of unreplaced deductible pints (maximum three).:contentReference[oaicite:9]{index=9}
Resources & Useful Links
Also see internal articles: UB‑04 billing guide, common denial reasons, and ICD‑10 coding tips.
Conclusion: value code 38
Correct reporting of value code 38 in 2025 ensures compliant handling of blood deductible units for Medicare billing. Use it only for unreplaced pints, cap entries at three per year, align with revenue codes, and maintain documentation. Staying current with official guidance helps preserve claim accuracy and payment integrity.