WASHINGTON — TRICARE, the Pentagon’s health insurance program, will test a new reimbursement model that pays civilian ambulance providers separately for blood administered before patients reach a hospital.
The Defense Health Agency, which oversees TRICARE for the Department of Defense, will launch the 5-year demonstration project on Jan. 1, 2027 and run through Dec. 31, 2031. It applies to authorized ground and air ambulance providers treating eligible military personnel, family members and retirees.
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Under the project, providers can receive an add-on payment for medically necessary whole blood, packed red blood cells, plasma or a combination of red blood cells and plasma administered during an ALS2, specialty care or air ambulance transport. Providers may also bill separately for the professional services involved in administering a transfusion.
The DHA said it will examine whether the reimbursement model improves outcomes for patients experiencing hemorrhagic shock, reduces overall healthcare costs and expands access to prehospital blood.
The project could also help determine whether separate reimbursement should become a permanent part of the TRICARE ambulance payment system.
Reimbursement cited as barrier to EMS blood programs
Although military medical teams have used prehospital blood for years, the practice remains limited among civilian EMS agencies.
Only about 1% to 2% of EMS agencies nationwide carry blood, according to America’s Blood Centers. Advocates say reimbursement is one of the largest barriers to starting and maintaining the programs.
Medicare and TRICARE generally reimburse ambulance services based on the level of care and transportation provided, with medical supplies included in the base payment. Prehospital blood transfusion qualifies a transport for the ALS2 rate, but the blood product itself is not reimbursed separately.
The DHA acknowledged that the additional ALS2 payment may not cover the cost of maintaining a prehospital blood program.
More than 70% of EMS agencies responding to a 2024 survey reported paying more than $500 per unit of blood, according to the Federal Register notice. More than one-third reported costs exceeding $800 per unit.
Those figures do not include all of the equipment, training and coordination required to keep blood available in ambulances. Agencies must closely monitor storage temperatures, train clinicians to administer the products, and coordinate with blood suppliers and hospitals to rotate unused units before they expire.
How ambulance providers will be paid
Under the demonstration, ambulance providers will be reimbursed at either the applicable hospital outpatient payment rate or the invoiced cost of the blood product, whichever is higher.
Providers that submit an invoice from a blood bank or supplier may receive reimbursement for the product’s actual cost. Those that do not submit an invoice will receive the hospital outpatient rate. Providers may also bill once per transport for transfusion administration services.
The add-on will apply to eligible patients covered by TRICARE Prime, TRICARE Select or TRICARE for Life, including those enrolled in Medicare Advantage plans. Claims outside the United States and its territories, along with cases in which another insurer is the primary payer, are excluded.
The DHA estimates the project will account for approximately $4.6 million in healthcare costs over 5 years, along with $100,000 in administrative expenses and $500,000 for evaluation.
The agency will review claims data during the project’s fifth year to determine whether the payment model improved outcomes, reduced costs and increased access to prehospital blood. The DHA may modify or end the project early if participation is limited or the reimbursement does not appear to meet those goals.
Would separate reimbursement for prehospital blood make your agency more likely to launch or expand a blood program? What other barriers would remain?
