Blood Clotting Factor Furnishing Fee
As of January 1, 2005, CMS will pay a furnishing fee for items and services associated with clotting factors, per the Medicare Modernization Act section 303(e)(1) added section 1842(o)(5)(C) of the Social Security Act.
In the CY 2025 PFS final rule (89 FR 97994 through 97997), we clarified existing policy that therapies that enable the body to produce clotting factors and do not directly integrate into the coagulation cascade (such as gene therapies treating hemophilia) are not themselves clotting factors for which the furnishing fee applies.
We include the clotting factor furnishing fee in the published national payment limits for clotting factor billing codes. When the national payment limit for a clotting factor is not included on the Medicare Part B Drug Payment Limit File or the Not Otherwise Classified (NOC) Pricing File, the contractor must make payment for the clotting factor and the furnishing fee.
CMS guidance requires physicians and other providers to bill using the appropriate HCPCS or CPT code and to accurately report the units of service. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, or other CMS local or national policy.
For regulatory information on blood clotting factors and furnishing fees, view 42 CFR § 410.63(b) and (c).