Summary & Overview
CPT 38228: Intravenous CAR–T Cell Therapy Infusion, Autologous
CPT code 38228 represents the intravenous administration of autologous chimeric antigen receptor T–cell (CAR–T) therapy, a specialized cellular immunotherapy for certain hematologic malignancies. As CAR–T therapies expand clinically, accurate coding for the infusion procedure is critical for consistent billing, authorization, and national tracking of utilization and costs. The code captures the administration phase distinct from cell collection and manufacturing services.
Key payers addressed in this coverage include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of how this procedure is classified and billed, operational considerations for sites of service, and a summary of what to expect in payer coverage policies. The publication outlines benchmarking elements commonly reported for advanced cellular therapies and highlights relevant policy and coding updates that affect claims processing and payer communications.
This summary prepares administrators, coders, and policy teams to understand where CPT code 38228 fits within the care pathway for CAR–T therapy, the typical delivery settings, and the payer landscape relevant to nationwide reimbursement and authorization practices. Data not available in the input will be indicated where applicable in detailed sections.
Billing Code Overview
CPT code 38228 describes the intravenous administration of chimeric antigen receptor T–cell (CAR–T) therapy using a patient’s own genetically modified T cells. This service involves preparing and infusing autologous CAR–T cells that have been manufactured to target specific tumor antigens.
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Service type: Cellular immunotherapy infusion
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Typical site of service: Inpatient hospital unit or outpatient specialty infusion center equipped for cellular therapy and management of infusion-related toxicities
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with relapsed or refractory B‑cell malignancy (for example, diffuse large B‑cell lymphoma) who has completed leukapheresis and CAR‑T cell manufacturing. The patient presents to an outpatient oncology infusion center or an inpatient hematology/oncology unit for administration of autologous chimeric antigen receptor T‑cell therapy. Pre‑infusion workup includes verification of cell product identity, baseline vital signs, laboratory tests (CBC, chemistries, liver and renal function), review of premedication orders (antipyretic and antihistamine), and assessment for active infection or concurrent immunosuppression. On the day of service, the provider documents informed consent for CAR‑T infusion, confirms product thaw and viability, and performs an intravenous infusion via a peripheral IV or central venous catheter. The team monitors the patient closely for acute infusion reactions, cytokine release syndrome, and neurotoxicity with frequent vital signs and neurologic assessments for several hours post infusion; many centers admit high‑risk patients for overnight observation or provide prolonged inpatient monitoring. Post‑infusion care includes orders for empiric antipyretics, corticosteroids or tocilizumab per institutional protocol if cytokine release syndrome occurs, documentation of the administered product lot and dose, and scheduling of follow‑up visits for toxicity surveillance and disease response assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |