Summary & Overview
CPT 36455: Therapeutic Blood Exchange for Severe Jaundice
CPT code 36455 represents a therapeutic blood exchange procedure in which a provider withdraws a measured amount of a patient’s blood and simultaneously replaces it with an equal volume of donor blood or plasma. The procedure is used to rapidly reduce circulating substances—commonly bilirubin—to treat severe jaundice and other acute conditions where immediate correction of blood components is required. Nationally, this code signals high-acuity, resource-intensive care typically delivered in hospital settings.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for use of the procedure, typical sites of service, and payer coverage considerations. The publication provides benchmarks and policy-relevant details about utilization patterns, coverage nuances, and billing practice considerations related to CPT code 36455, along with clinical context that helps clarify appropriate settings for the service. Data not available in the input will be identified explicitly where relevant.
This summary is intended for clinicians, revenue cycle leaders, and policy analysts seeking a concise reference on the clinical purpose and payer landscape for CPT code 36455 at a national level.
Billing Code Overview
CPT code 36455 describes a therapeutic procedure in which a provider removes a specific volume of a patient’s blood (other than a newborn) and simultaneously replaces it with an equal volume of donor blood or plasma. This exchange is performed to rapidly reduce circulating levels of substances such as bilirubin and is commonly used for severe jaundice and other conditions requiring immediate control of blood constituents.
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Service type: Therapeutic blood exchange (therapeutic plasmapheresis/blood exchange)
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Typical site of service: Hospital inpatient unit or hospital outpatient infusion/pheresis center
Clinical & Coding Specifications
Clinical Context
A 32-year-old pregnant woman at 28 weeks’ gestation with severe immune-mediated hemolytic disease of the fetus and newborn (alloimmune hemolytic disease) presents for intrauterine exchange transfusion. The fetal medicine team confirms signs of hydrops fetalis on ultrasound and rising middle cerebral artery peak systolic velocity consistent with fetal anemia. Under ultrasound guidance and with maternal-fetal monitoring, the interventional fetal medicine specialist or pediatric surgeon performs fetal blood removal via umbilical vein access and simultaneously transfuses cross-matched, irradiated, leukoreduced donor blood of equal volume to correct fetal anemia and reduce bilirubin production. Typical workflow includes maternal informed consent, preprocedure crossmatch and infectious disease testing of donor blood, ultrasound localization, sterile prep, fetal sedation as indicated, vascular access to the umbilical cord or placenta, controlled phlebotomy of fetal blood, infusion of matched donor red blood cells or plasma, hemostasis monitoring, postprocedure fetal monitoring and ultrasound, and documentation of volumes removed and infused, blood products used, and immediate fetal response.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified — use payer-specific when required | Use only if a payer requires a placeholder modifier; uncommon in clinical claims. |