Summary & Overview
CPT 36514: Therapeutic Plasma Exchange (Apheresis)
CPT code 36514 designates therapeutic plasma exchange (apheresis) for removal of plasma, a targeted hematologic procedure used to treat a range of immune-mediated and metabolic conditions by extracting plasma and returning formed blood elements. Nationally, this code is significant for hospitals and specialty infusion centers because it captures a high-resource service that requires specialized equipment, trained staff, and defined care settings.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context and service settings, typical payer coverage considerations, and what to expect in billing and claim reporting. The publication also summarizes benchmark topics such as utilization drivers, site-of-service implications, and documentation elements commonly reviewed by payers.
This summary is intended to orient clinicians, billing professionals, and policy analysts to the core meaning and health-system implications of CPT code 36514, explain where the procedure is typically performed, and identify the primary payer stakeholders referenced in coverage discussions. Data not available in the input are noted where applicable in the full publication.
Billing Code Overview
CPT code 36514 describes therapeutic plasma exchange (apheresis) for removal of plasma, a procedure that uses specialized equipment to selectively remove the plasma portion of whole blood and retransfuse the cellular components to the patient. The procedure is reported when plasma is the constituent removed from the circulation.
Service Type: Therapeutic apheresis / plasma exchange
Typical Site of Service: Hospital inpatient or outpatient apheresis unit, specialty infusion center, or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with refractory myasthenia gravis presents with progressive weakness and respiratory compromise despite optimized medical therapy. The neurology team orders therapeutic plasma exchange to remove circulating pathogenic autoantibodies. The patient arrives to an outpatient apheresis unit or an inpatient apheresis-capable infusion center or hospital procedural suite. Venous access is obtained via peripheral dual-lumen catheter or a temporary central venous catheter if peripheral access is inadequate. Anticoagulation is managed per institutional protocol (typically systemic heparin or regional citrate during the procedure). The apheresis team performs plasma exchange using apheresis equipment to separate and remove plasma, replacing it with albumin and/or fresh frozen plasma as clinically indicated. Vitals, intraprocedural anticoagulation, and replacement volumes are monitored. Post-procedure, the patient is observed for hemodynamic stability, bleeding at the access site, citrate reactions, and signs of infection; laboratory tests (CBC, coagulation studies, electrolytes) are reviewed. The planned course is multiple treatments over several days depending on clinical response and neurologist guidance. Billing for the plasma exchange procedure uses 36514 for each therapeutic plasma exchange session targeting removal of the plasma component.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service on same day |