Cpt code 38243. Inclusion or exclusion of a procedure, diagnosis or device code (s)...

Cpt code 38243. Inclusion or exclusion of a procedure, diagnosis or device code (s) does not constitute or imply member coverage or provider reimbursement policy. All rights reserved. Procedure Details Hematopoietic stem cell transplants, including peripheral blood, bone marrow, and cord blood transplants are used most often to treat cancers affecting the blood or immune system. Bone marrow stem cells may be obtained from the transplant recipient (autologous HCT) or a donor (allogeneic HCT). They can be harvested from bone marrow CPT Code 38243 Medicare Reimbursement CPT code 38243, which is associated with a specific medical procedure, may be reimbursed by Medicare, but this is contingent upon several factors. Option 38746: Code 38746 is an add-on code for radical retroperitoneal Transplantation and Post-Transplantation Cellular Infusions (38240-38243) used to report transplantation and post-transplantation cellular infusions Bone marrow or blood-derived peripheral stem cell transplantation 38240-38243 *codes are differentiated by allogenic transplantation, autologous transplantation, and allogenic donor lymphocyte Jan 6, 2026 · Coding The following codes for treatments and procedures applicable to this document are included below for informational purposes. e. Add-on codes can never be reported alone. CPT code 38243 is used to report a transplant-related hematopoietic cell boost procedure, where additional stem cells are collected to enhance the therapeutic effect after an initial transplant. Medical Necessity Aetna considers the following indications as medically necessary (unless otherwise stated): Compatibility testing of prospective donors who are close family members (first-degree relatives (i. CPT 38230: Bone marrow harvesting from a donor. There are two main types of stem cell transplant: autologous and allogeneic. CPT code 38243, which is associated with a specific medical procedure, may be reimbursed by Medicare, but this is contingent upon several factors. CPT 38242: Infusing donor lymphocytes to boost the patient’s immune system. © Copyright 2025 Coding Ahead. Vignettes are reviewed annually and updated when necessary. Hematopoietic stem cells may be obtained from the transplant recipient (autologous HCT) or a CPT Code 38243 Medicare Reimbursement CPT code 38243, which is associated with a specific medical procedure, may be reimbursed by Medicare, but this is contingent upon several factors. e Bill and report an allogeneic boost using CPT code 38243 – “hematopoietic progenitor cell (HPC); HPC boost”. Hematopoietic Cell Transplantation HCT is a procedure in which hematopoietic stem cells are infused to restore bone marrow function in cancer patients who receive bone-marrow-toxic doses of drugs with or without whole body radiotherapy. The Medicare Physician Fee Schedule (MPFS) is a crucial resource for determining whether a particular CPT code is covered and the reimbursement rate. Feb 22, 2026 · CPT® Code 38243 in section: Hematopoietic progenitor cell (HPC) CPT® Vignettes illustrate code use through sample patient examples. If a patient was admitted to the hospital for observation, was released, and is then admitted as an inpatient for alloHCT Hematopoietic Cell Transplantation Hematopoietic cell transplantation is a procedure in which hematopoietic stem cells are intravenously infused to restore bone marrow and immune function in cancer patients who receive bone marrow-toxic doses of cytotoxic drugs with or without whole-body radiotherapy. , parents, siblings and children) or second degree relatives (i. The Current Procedural Terminology (CPT ®) code 38243 as maintained by American Medical Association, is a medical procedural code under the range - Transplantation and Post-Transplantation Cellular Infusion Procedures on the Hemic and Lymphatic Systems. . Feb 12, 2023 · Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin This boost is distinct from a repeat transplant, as it does not necessitate the recipient undergoing any pre-transplant myeloablative or immunosuppressive conditioning, making it a targeted intervention aimed at enhancing the effectiveness of the initial transplant. Where appropriate, there are also Pre- and Post-service descriptions. Check national averages, RVU breakdowns, and local payment adjustments. Here are some important CPT codes used in stem cell transplants: CPT 38220: Bone marrow aspiration, often done before the transplant. Public Comments See National Coverage Analyses (NCAs) Open for Public Comment See Coding Analysis for Labs (CALs) Open for Public Comment See Medicare Coverage Documents Open for Public Comment Please Note: There are currently no National Coverage Documents open for public comment. CPT Code 38243 Medicare Reimbursement CPT code 38243, which is associated with a specific medical procedure, may be reimbursed by Medicare, but this is contingent upon several factors. 300-400 new vignettes are Aug 19, 2024 · The Current Procedural Terminology (CPT) code range for Transplantation and Post-Transplantation Cellular Infusion Procedures on the Hemic and Lymphatic Systems 38240-38243 is a medical code set maintained by the American Medical Association. Every vignette contains a Clinical Example/Typical Patient and a description of Procedure/Intra-service. Add-on codes are used to describe procedures that are always performed in addition to another primary procedure. So Option 38102 is correct. Code 38102 is not an add-on code. Policy Scope of Policy This Clinical Policy Bulletin addresses stem cells for hematopoietic cell transplant. Here are further explanations: Option 38243: Code 38243 is an add-on code for H-P-C transplantation. Current 2026 Medicare pricing for HCPCS/CPT code 38243. fgi hdb bpf ulk orj ghm ico hxy bsk emy ipf yiw qte fun dii