Summary & Overview
CPT 0748T: Stem Cell Injection for Perianal Fistula
CPT code 0748T represents a targeted stem cell injection into soft tissue around an anal or perianal fistula. This emerging regenerative procedure addresses complex fistulous disease that may be refractory to conventional surgical approaches. As novel biologic therapies expand, accurate coding for these services is critical for clinical tracking, payment determination, and coverage policy development nationwide.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement policies vary across commercial plans and Medicare, reflecting differences in evidence review, medically necessary criteria, and prior authorization requirements.
Readers will find an overview of the clinical context for perianal fistula management and what CPT code 0748T specifically denotes, plus discussion of payer coverage landscape, common billing modifiers, and relevant considerations for documentation and site-of-service selection. The publication highlights benchmark topics such as claim coding practices, utilization drivers for regenerative procedures, and policy themes that payers consider when evaluating coverage for novel biologic interventions. Data not provided in the input are indicated where applicable.
Billing Code Overview
CPT code 0748T describes a procedure in which a provider injects stem cells into the soft tissue surrounding a fistula near the anus. This service is a minimally invasive regenerative therapy targeting anal or perianal fistulous tracts and associated soft tissues.
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Service type: Soft-tissue stem cell injection for fistula management
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Typical site of service: Ambulatory surgical center or hospital outpatient setting where image guidance or minor operative intervention can be provided
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a perianal fistula (commonly related to Crohn disease, cryptoglandular infection, or post‑surgical disruption) who has persistent drainage, pain, or recurrent abscess despite conventional therapy. The patient presents to an outpatient specialty clinic (colorectal surgery or gastroenterology) for evaluation. Pre‑procedure workup includes history and physical exam, anorectal imaging when indicated (endoanal ultrasound or pelvic MRI), assessment of infection control, and optimization of comorbidities. On the day of service the procedure is performed in an ambulatory surgery center or hospital outpatient department under local anesthesia with sedation or monitored anesthesia care; the provider identifies the fistula tract and injects autologous or allogeneic stem cells into the soft tissue surrounding the fistula opening to promote healing and reduce inflammation. Post‑procedure workflow includes observation for anesthesia recovery, wound care instructions, short‑term antibiotics if indicated, scheduled follow‑up for wound assessment and imaging as needed, and documentation of informed consent, procedural details, cell product lot number, and any immediate complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work or time substantially exceeds typical for the procedure due to complexity or unexpected findings |
23 | Unusual anesthesia | When general anesthesia is medically necessary but not typically used for this procedure |
51 | Multiple procedures | When another distinct procedure is billed on the same day by the same provider |
52 | Reduced services | When the procedure is started but not completed or performed in a reduced manner |
53 | Discontinued procedure | When the procedure is terminated due to extenuating circumstances after initiation |
62 | Two surgeons | When two surgeons work together as primary surgeons during the procedure |
66 | Surgical team | When a surgical team performs the procedure for complex cases |
78 | Return to operating/procedure room after anesthesia | When the patient returns to the procedure room for a related procedure during the global period |
80 | Assistant surgeon | When an assistant surgeon is required and billed separately |
81 | Minimum assistant surgeon | When minimal assistance is provided and billed accordingly |
82 | Assistant surgeon (when qualified resident not available) | When an assistant surgeon is used because no qualified resident is available |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service as primary surgeon | When an advanced practice provider performs the procedure as the primary operator where allowed |
QX | Service furnished by a physician assistant with a modifier identifying the supervising physician | When a physician assistant performs the service under physician supervision |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RC0000X | Colorectal Surgery | Colorectal surgeons commonly perform perianal fistula procedures and advanced biologic therapies |
| 2080P0207X | Gastroenterology | Gastroenterologists manage Crohn‑related fistula disease and coordinate care for biologic interventions |
| 208800000X | General Surgery | General surgeons with interest in anorectal surgery may perform this procedure |
| 363A00000X | Hematology & Oncology (cell therapy specialists) | Providers involved when stem cell product handling or infusion coordination is required |
| 2086S0123X | Colon & Rectal Surgery (Assistant/Provider) | Ancillary colorectal specialists or assistants participating in procedure |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K60.3 | Fistula of anal and rectal regions | Primary diagnosis indicating presence of an anal fistula targeted by stem cell injection |
K50.114 | Crohn disease of small intestine with intestinal perforation, with abscess | Crohn disease with perianal complications commonly leads to complex fistulas requiring advanced therapies |
K51.114 | Ulcerative colitis, unclassified, with intestinal perforation, with abscess | Inflammatory bowel disease with perianal involvement can be an indication for biologic or cellular therapies |
K60.2 | Anal fistula, unspecified | General code used when fistula specifics are not fully characterized at encounter |
K61.0 | Abscess of anal and rectal regions | Associated abscesses often require drainage before or in conjunction with fistula treatment |
R10.9 | Abdominal pain, unspecified | Symptom code that may accompany perianal disease presentations |
Z48.02 | Encounter for removal of internal fixation device | Included when prior surgical hardware or plugs are removed as part of fistula management |
Z79.899 | Other long term (current) drug therapy | Used when concurrent long‑term immunosuppressive or biologic therapy is being administered and documented |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
46040 | Fistulectomy, simple, with primary repair | May be performed when excision of a simple perianal fistula is indicated instead of or prior to stem cell injection |
46255 | Ligation of anal fistula tract (LIFT procedure) | Alternative sphincter‑sparing surgical technique often used for complex fistula management |
49020 | Abdominal drainage of perirectal or perianal abscess; closed or open | May be performed prior to definitive fistula therapy to control sepsis |
76942 | Ultrasound guidance for needle placement (eg, cyst drainage, abscess) | Used when imaging guidance is needed to localize the fistula tract for accurate stem cell injection |
81550 | Therapeutic, prophylactic, or diagnostic genetic test (example cell product testing placeholder) | Represents specialized laboratory or cell product testing steps related to stem cell handling in some workflows |
99024 | Postoperative follow-up visit, global period, related to the procedure | Used for routine global postoperative follow‑up care following the injection procedure |