CPT 0586T: Open Pancreatic Islet Cell Transplantation via Portal Vein Infusion - OpenPayer

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Summary & Overview

CPT 0586T: Open Pancreatic Islet Cell Transplantation via Portal Vein Infusion

CPT code 0586T designates an open (laparotomy) pancreatic islet cell transplantation where pancreatic beta islet cells from an autologous or donor source are infused into the portal vein to restore insulin production. This emerging surgical cellular-therapy procedure is significant for patients with insulin-dependent diabetes and for payers assessing coverage for advanced transplant and cellular therapies. The code explicitly includes imaging, imaging guidance, and radiological supervision and interpretation as part of the procedure.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical procedure and site-of-service considerations, plus national benchmarking context and common billing modifiers used with complex surgical transplant procedures. The publication summarizes reimbursement benchmarks where available, outlines clinical and coding considerations relevant to transplant centers and surgical teams, and highlights policy updates that affect coverage and billing workflows for advanced cellular therapies.

The content is written for a national audience of health system billing administrators, transplant program directors, and payer policy analysts. Data not available in the input are identified as such; the report focuses on the code definition, service type, typical site of service, payers covered, and practical coding context for institutions managing islet cell transplantation cases.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare0586TCPTIslet Cell TransplantationPancreatic TransplantSurgical OncologyCellular TherapyTransplant BillingPortal Vein Infusion

Billing Code Overview

CPT code 0586T describes an open (laparotomy) pancreatic islet cell transplantation procedure in which pancreatic beta islet cells from an autologous or donor source are transplanted to stimulate insulin production. The provider infuses the islet cells into the portal vein of the liver through a tube inserted via an abdominal incision. All imaging, imaging guidance, and radiological supervision and interpretation are included in the procedure description.

Service type: Surgical transplant procedure (open abdominal laparotomy) involving vascular infusion of cellular therapy

Typical site of service: Inpatient or ambulatory surgical center with operating room capability; performed in a surgical suite or transplant center that supports open abdominal procedures and interventional radiology resources.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 30–65-year-old adult with insulin-dependent diabetes mellitus being evaluated for autologous or allogeneic pancreatic islet cell transplantation when conventional medical management fails to achieve safe glycemic control or when recurrent severe hypoglycemia or hypoglycemia unawareness occurs. The multidisciplinary workflow begins with endocrinology and transplant surgery evaluation, metabolic and immunologic workup, and imaging to assess portal/hepatic anatomy. On the day of service, the patient undergoes general anesthesia in an operating room or ambulatory surgical center configured for major invasive procedures. The surgeon performs a laparotomy to access the abdominal cavity, obtains islet cells (autologous harvest from the pancreas or imported donor islets), and prepares a catheter. Under direct visualization and with fluoroscopic or ultrasound guidance, the surgeon inserts a catheter into the portal vein via an abdominal incision and infuses the islet cell suspension into the portal circulation. Intraoperative radiologic imaging and interpretation are included in the service. Post-procedure, the patient is monitored in a post-anesthesia care unit and then a step-down or transplant unit for graft function, bleeding, portal vein thrombosis surveillance, infection prophylaxis, and immunosuppression management as indicated. Typical sites of service are hospital inpatient or hospital outpatient operating room settings where laparotomy and portal vein catheterization can be performed safely.

Coding Specifications

Modifier	Description	When to Use
`22`

Taxonomy Code	Specialty	Notes
208900000X	General Surgery	Primary surgical specialty performing laparotomy, portal vein access, and islet infusion.
207L00000X	Transplant Surgery	Specialty focused on organ and islet transplantation and perioperative management.
207Q00000X	Endocrinology	Refers patients for islet transplantation, manages diabetes and post-transplant metabolic care.
2086S0122X	Interventional Radiology	Provides imaging guidance, portal vein catheterization assistance and intraoperative fluoroscopy/ultrasound support.
207R00000X	Anesthesiology	Provides general anesthesia and perioperative anesthetic management for `0586T`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E10.9`	Type 1 diabetes mellitus without complications	Common indication for islet cell transplantation when insulin-dependent diabetes is refractory to conventional therapy.
`E13.9`	Other specified diabetes mellitus without complications	Applicable when diabetes of other specified types leads to insulin dependence and consideration for islet transplantation.
`E11.65`	Type 2 diabetes mellitus with hyperglycemia	Selected patients with severe insulin-dependent type 2 diabetes may be considered for islet transplantation in some protocols.
`E10.641`	Type 1 diabetes mellitus with hypoglycemia with coma	Severe recurrent hypoglycemia is a clinical reason to consider islet transplantation to restore endogenous insulin regulation.
`E10.649`	Type 1 diabetes mellitus with hypoglycemia without coma	Hypoglycemia unawareness or recurrent severe hypoglycemia drives consideration for islet transplantation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`48150`	Pancreatectomy, total or subtotal, with or without splenectomy (separate procedure)	May be performed when harvesting autologous islets requires partial pancreatectomy prior to islet isolation and subsequent `0586T` infusion.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	May be used for perioperative central venous access for fluids, medications, or immunosuppression associated with `0586T` care.
`76937`	Ultrasound guidance for vascular access requiring ultrasound evaluation and guidance; 1 or more attempts	Used when ultrasound guidance is employed to access the portal vein or intrahepatic branches during catheter placement for `0586T`.
`74240`	Radiological supervision and interpretation, portal venous system, including indirect portography, percutaneous transhepatic (diagnostic)	May be used for diagnostic portal venography or imaging adjuncts during planning or complications evaluation related to `0586T`.
`11981`	Initial injection for subcutaneous infusion device implantation (not exact but related infusion management)	May be relevant to adjunctive infusion device procedures for postoperative management; included as a perioperative related infusion procedure when clinically indicated.