Summary & Overview
CPT 0264T: Autologous Bone Marrow Muscle Injection for Peripheral Artery Disease
CPT code 0264T identifies an autologous bone marrow injection procedure in which already harvested bone marrow is prepared and injected into muscle tissue to treat advanced peripheral artery disease and similar ischemic conditions. The code captures a biologic, minimally invasive therapy aimed at improving limb perfusion and reducing the need for major amputation in patients with end-stage peripheral vascular disease. Nationally, this code matters as payers and health systems assess coverage, clinical utility, and appropriate site-of-service for novel cellular therapies.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, typical sites of service, and which payers commonly appear in coverage discussions for procedures of this type. The publication also outlines where to look for benchmarks and policy updates, summarizes the clinical context for use in limb salvage and ischemia management, and flags areas where additional coding, clinical, or policy information is needed. Data not available in the input is noted where applicable, including specific coverage policies, utilization benchmarks, and associated ICD-10 diagnoses.
Billing Code Overview
CPT code 0264T describes a procedure in which a provider prepares previously harvested bone marrow and injects it into the patient's muscles to treat conditions such as end-stage peripheral artery disease. This procedure is a form of autologous bone marrow injection therapy intended to promote tissue perfusion and limb salvage in severe vascular disease.
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Service type: Cellular or biologic autologous bone marrow injection procedure
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Typical site of service: Outpatient procedure suite or ambulatory surgical center, or hospital outpatient setting
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with end-stage peripheral artery disease (PAD) presents with chronic rest pain and non-healing ischemic ulcers of the lower extremity despite optimal medical therapy and prior endovascular interventions. After multidisciplinary evaluation including vascular surgery and interventional radiology, the patient is selected for intramuscular autologous bone marrow cell injection to promote angiogenesis and limb salvage.
The clinical workflow: the patient undergoes bone marrow aspiration (typically from the posterior iliac crest) in an operating room or procedure suite under conscious sedation or regional anesthesia. The harvested marrow is processed on-site to concentrate mononuclear cells. The provider injects the prepared autologous bone marrow concentrate into multiple sites of the ischemic limb muscles using sterile technique. Post-procedure monitoring occurs in the recovery area with neurovascular checks, pain control, and wound care. Follow-up visits at 2–6 weeks assess perfusion, wound healing, and need for additional interventions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no distinct modifier applies; follows payer rules for default reporting |
22 | Increased procedural services | Use when work or technical effort is substantially greater than typical (e.g., unusually difficult injections or extensive cell preparation) |
23 | Unusual anesthesia | Use if general anesthesia is medically necessary and not normally used for this procedure |
52 | Reduced services | Use if the procedure is partially reduced or not completed as originally planned |
53 | Discontinued procedure | Use if the procedure is started but terminated due to extenuating circumstances or patient condition |
62 | Two surgeons | Use when two surgeons from different specialties are required and both actively participate |
66 | Surgical team | Use when services are provided by a surgical team with documented roles |
78 | Return to OR for related procedure during global period | Use if the patient returns to the operating room for a related procedure during the global period |
80 | Assistant at surgery | Use when a surgical assistant is documented and paid separately |
81 | Minimum assistant at surgery | Use when a minimum assistant is documented per payer requirements |
82 | Assistant not available | Use when a qualified resident or assistant is not available and an assistant is required |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist | Use when a certified PA, NP, or CNS performs or assists and billing rules permit |
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Use if the physician directs concurrent anesthesia for multiple procedures including this one |
QX | CRNA with medical direction by a physician | Use when a CRNA provides anesthesia under physician medical direction |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Vascular Surgery | Vascular surgeons frequently evaluate and perform or coordinate limb salvage procedures |
| 207P00000X | Interventional Radiology | Interventional radiologists may perform aspiration, delivery, or image-guided injections |
| 2080P0206X | Pain Medicine | Pain specialists may participate in injection delivery and peri-procedural pain control |
| 208D00000X | Physical Medicine & Rehabilitation | PM&R specialists manage functional outcomes and rehabilitation after procedure |
| 208000000X | Surgery | General surgeons in some systems participate in limb salvage programs |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
38220 | Transplant, bone marrow; aspirate for diagnostic purposes | May be used when bone marrow aspiration is performed as a separate billable service prior to processing for therapeutic use |
38221 | Bone marrow harvest for transplantation; from iliac crest | Relevant when harvest is more extensive or distinct from aspiration for concentrate preparation |
38230 | Bone marrow harvesting for transplantation; from vertebral body(s) | Rarely used; applicable if an alternate harvest site is used and documented |
96409 | Chemotherapy administration, subcutaneous or intramuscular; non-hormonal, first drug | May be used in documentation workflows when intramuscular injections are reported; verify payer rules before use |
99024 | Postoperative follow-up visit, normally included in the global service; only used for unrelated visits | Use to document unrelated post-op visits if billed separately per payer rules |