One CPT Code, Many Prices: What Does Apheresis Actually Cost?
How much does apheresis cost, and how much are we reimbursed? I’ve been asking myself that for a while. It’s harder to answer than it sounds, because “how much” hides three different numbers.
Cost is what it takes the hospital to deliver the procedure: the kit, the albumin, the nurse’s time, the machine and its upkeep. Charge is the price the hospital puts on the procedure in its price list, called a chargemaster. Reimbursement is what a payer actually pays. The three are related, but they are rarely close. Researchers capture the gap with a charge-to-reimbursement ratio: the price charged divided by the amount actually reimbursed [3].
Charges are set at the hospital’s discretion, and it’s unclear which patients, if any, pay them. Insurers negotiate their own rates, often as a percentage of the chargemaster price [3]. Medicare publishes its rates every year [1]. Even physicians aren’t immune to the confusion. The authors of one study note that medical professionals often have limited understanding of billing procedures [3].
The Same Procedure, Many Prices
A group of pathologists looked at one apheresis procedure, extracorporeal photopheresis, at 20 US hospitals in 2022. They chose it because the kit, the machine, and the medication are the same everywhere [3]. Chargemaster list prices ran from about $3,600 to $34,000 per procedure. The negotiated rates hospitals were paid ranged from $104.50 to $18,484.00 [3].
Payers differed too. Among hospitals that posted them, the average rate paid by private insurance was about $7,277 and the average Medicare rate was about $3,604 [3]. The charge-to-reimbursement ratio was 3.37 for Medicare and 1.88 for commercial payers [3].
The average hospital posted nearly a hundred negotiated rates for this one procedure, and the 14 hospitals that posted rates had 90 separate entries for Aetna alone [3]. That means that the reimbursement the hospital receives is different depending on who was paying for it.
How Medicare Pays: Outpatients
Everything in this section and the next describes Medicare.
In the outpatient setting, Medicare pays one flat payment per procedure, set by CPT code. It doesn’t matter which replacement fluid we use, which labs we send, or which medications we give. The payment is the same, although it changes year over year.
CPT | Procedure | 2026 final | 2027 proposed |
36514 | Apheresis, plasma | $1,591.16 | $1,807.56 (+13.6%) |
36511 | Apheresis, WBC | $1,591.16 | $1,807.56 (+13.6%) |
36512 | Apheresis, RBC | $1,591.16 | $1,807.56 (+13.6%) |
36513 | Apheresis, platelets | $450.73 | $510.12 (+13.2%) |
36516 | Selective immunoadsorption | $4,449.84 | $4,866.48 (+9.4%) |
36522 | Photopheresis | $4,449.84 | $4,866.48 (+9.4%) |
2026 rates are final [1]. 2027 rates are CMS’s proposed rates and may change [2].
How Medicare Pays: Inpatients
For inpatients, we aren’t paid directly. The hospital receives a diagnosis-related group payment, or DRG. A DRG sorts a hospital stay into a category by diagnosis and treatment, and pays one amount for the whole stay [3]. The bed, the drugs, the labs, and the apheresis are all covered by that single payment. There is no apheresis fee to point to.
And What Does It Cost?
That’s the number nobody posts. A cost analysis of 246 patients in Tehran put the median direct cost at about 197 million rials per session, roughly $690 at the authors’ illustrative exchange rate. Apheresis sets made up 39.4% of the total, albumin 38.7%, and a “service fee” 14.3% [4]. I wanted to know what that service fee covers. The paper doesn’t say, and it leaves out indirect costs [4].
A systematic review of LDL apheresis found US per-session costs between $2,202 and $4,403 in 2015 dollars, and about $1,276 to $1,392 in Germany and France [5]. Of the seven articles that reported costs, only two cited a source [5]. The Canadian health technology assessments stood out. They spread equipment costs over ten years and counted maintenance, disposables, and physician and nurse costs [5]. That’s the list I’d want every analysis to use.
These numbers can’t be lined up against each other. They come from different countries, years, and procedures, and they count different things.
Where That Leaves Us
Medicare pays one number per code. The average hospital in one study posted nearly a hundred negotiated rates for a single procedure. And what an apheresis service costs depends on who counted and what they counted.
If payment is so variable and cost depends on who’s counting, how would we ever know whether an apheresis service pays for itself?
References
Association for the Advancement of Blood & Biotherapies. CMS CY 2026 Medicare Hospital Outpatient Prospective Payment System (OPPS) Final Rule Summary and Payment Rates.
Association for the Advancement of Blood & Biotherapies. CMS Proposed Medicare Hospital Outpatient Payment Rates and Policies for CY 2027.
Adkins BD, Booth GS, Jacobs JW, Jones H, Mouslim MC, Henderson MA. Outpatient apheresis billing: a photopheresis model shows that hospital price transparency data remain difficult to interpret. Am J Clin Pathol. 2023;160:404-410. doi:10.1093/ajcp/aqad059
Mahmoudi PS, Hadipour Kelidsari A, Dashti-Khavidaki S, Davari M, Khalili H. Therapeutic plasma exchange: a cost-consequence analysis using data from a tertiary care hospital. J Clin Apher. 2026;41:e70203. doi:10.1002/jca.70203
Wang A, Richhariya A, Gandra SR, et al. Systematic review of low-density lipoprotein cholesterol apheresis for the treatment of familial hypercholesterolemia. J Am Heart Assoc. 2016;5:e003294. doi:10.1161/JAHA.116.003294
