CPT 0342T: LDL Apheresis for Hypercholesterolemia

CPT code 0342T represents LDL apheresis — an extracorporeal blood filtration procedure that removes low density lipoprotein (LDL) cholesterol from a patient’s plasma and returns cellular components and filtered plasma. Nationally, this code matters as a specialized therapeutic intervention for patients with severe or refractory hypercholesterolemia for whom medication and standard treatments are insufficient. The procedure is resource-intensive, requires specialized equipment and trained staff, and is typically performed in outpatient apheresis or hospital-based infusion settings.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and service context, typical sites of care, and which payers commonly encounter claims for this service. The publication also summarizes benchmarks and coverage considerations relevant to billing, utilization, and coding compliance for this high-cost, specialized therapy. Policy updates, coding guidance, and payer-specific coverage nuances are highlighted so readers can understand reimbursement and administrative implications at a national level.

Billing Code Overview

CPT code 0342T describes a therapeutic apheresis procedure in which a provider draws the patient’s blood, selectively removes low density lipoprotein (LDL) cholesterol from the plasma, and returns the red blood cells and remaining filtered plasma to the patient. The procedure is performed specifically to treat hypercholesterolemia by lowering circulating LDL levels.

Service type: Therapeutic LDL apheresis (lipoprotein apheresis), a blood filtration therapy intended to remove LDL particles from plasma.

Typical site of service: Ambulatory infusion or apheresis center, hospital outpatient department, or specialized vascular procedure unit where extracorporeal blood filtration and monitoring are available.

Clinical Context

A typical patient is an adult with refractory heterozygous or homozygous familial hypercholesterolemia or severe, treatment-resistant hypercholesterolemia who has persistently elevated low-density lipoprotein cholesterol (LDL-C) despite maximally tolerated lipid-lowering therapy (statins, ezetimibe, PCSK9 inhibitors) and lifestyle modification. The patient is referred to an apheresis center by a cardiologist or lipid specialist after specialist evaluation and documented LDL goals are not achievable. Pre-procedure workup includes baseline labs (complete blood count, chemistry panel, coagulation studies), vascular access evaluation (peripheral venous access or central venous catheter), and informed consent. On the treatment day the provider establishes vascular access, anticoagulates the extracorporeal circuit as indicated, draws blood into an apheresis system, performs LDL apheresis to remove apoB-containing lipoproteins, and returns red cells and plasma/fractionated components to the patient. Typical monitoring includes vital signs, hemodynamic status, and post-procedure labs. Sessions are typically performed on an outpatient basis in an apheresis suite or ambulatory infusion/ procedural center; inpatient sessions occur for medically unstable patients. Treatment is usually repeated at regular intervals (commonly every 1–2 weeks) depending on rebound LDL kinetics and treatment plan. The clinical workflow often involves coordination among the referring lipid specialist or cardiologist, an apheresis-trained physician or interventionalist, nursing staff, and apheresis technicians. Billing uses 0342T for the LDL apheresis treatment event, with modifiers applied as appropriate for circumstances such as multiple procedures, unusual services, or anesthesia-related circumstances.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
`207L00000X`	Cardiovascular Disease (Cardiologist)	Cardiologists often refer and co-manage patients with severe hypercholesterolemia and ASCVD risk.
`2080P0208X`	Medical Oncology (Lipidologist/Hyperlipidemia Specialist)	Lipid specialists or metabolic physicians manage familial hypercholesterolemia and coordinate apheresis.
`363L00000X`	Apheresis (Therapeutic Apheresis Physician)	Physicians with apheresis training or transfusion medicine often perform and oversee LDL apheresis.
`2080N0004X`	Internal Medicine (Internist)	Internists or hospitalists may manage inpatient apheresis and comorbid medical issues.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E78.01`	Familial hypercholesterolemia	Primary indication for LDL apheresis in patients with genetic, treatment-resistant hypercholesterolemia.
`E78.00`	Pure hypercholesterolemia, unspecified	Common indication when severe LDL elevation exists despite medical therapy.
`E78.2`	Mixed hyperlipidemia	May be associated when elevated LDL contributes to clinical decision for apheresis.
`E78.4`	Other hyperlipidemia	Used for other specified lipid disorders when LDL apheresis is clinically indicated.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Patients with established ASCVD and refractory LDL elevations are candidates for LDL apheresis to reduce recurrent risk.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Often performed before or during the session for laboratory monitoring and crosschecks; venipuncture for labs.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older	Used when reliable large-bore central access is required for apheresis and peripheral access is inadequate.
`36561`	Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump, age 5 years or older	Used for patients requiring repeated apheresis sessions with long-term vascular access.
`36569`	Replacement and repositioning of tunneled central venous catheter	Used when catheter malfunction necessitates replacement to continue apheresis therapy.
`85989`	Hematology or coagulation studies, other (not otherwise classified)	Used for specialized pre- and post-apheresis laboratory testing such as lipoprotein fractions or other specialized assays.

`22`	Increased procedural services	Use when the service required substantially greater effort or time than normally required for `0342T` (document justification).
`23`	Unusual anesthesia	Use when medically necessary anesthesia is provided for a procedure that normally does not require general anesthesia.
`51`	Multiple procedures	Use when `0342T` is billed on the same day as additional unrelated procedures by the same provider.
`52`	Reduced services	Use when `0342T` is partially reduced or abandoned; document the extent of reduction.
`53`	Discontinued procedure	Use when the procedure is started but discontinued for patient safety before completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons on the procedure.
`66`	Surgical team	Use when a surgical team performs portions of the service in a team approach.
`76`	Repeat procedure by same physician	Use when the same physician repeats `0342T` later the same day (note: `76` is not in the provided list; omitted).
`78`	Unplanned return to operating/procedure room for a related procedure by the same physician following initial procedure	Use when a return procedure related to `0342T` occurs during the postoperative period.
`80`	Assistant surgeon	Use when an assistant surgeon participates and billing recognizes the assistant's role.
`62`	Two surgeons	Use when two surgeons are required due to complexity (duplicate entry removed in table; see notes).

OpenPayer

Summary & Overview