CPT 38240: Donor Hematopoietic Progenitor Cell Infusion
CPT code 38240 denotes the infusion of hematopoietic progenitor cells (HPCs) harvested from a donor and administered into a recipient’s bloodstream. This donor-derived cellular therapy is central to allogeneic hematopoietic cell transplantation and is used to restore hematopoietic function in patients with marrow failure, malignant hematologic disorders, or selected non-malignant conditions. Nationally, procedures billed under this code represent high-acuity, resource-intensive care that intersects inpatient services, specialized transplant programs, and payer medical policy for complex therapies.
Key payers commonly involved in coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, the typical care setting, and the payer landscape addressed in coverage discussions. The publication also outlines what to expect in benchmarking and policy context: utilization drivers for transplant procedures, typical site-of-service implications, and areas where payer policies or prior authorization practices frequently apply. Where available, benchmarks and policy updates relevant to transplantation services will be summarized; if specific payer benchmark data are not present in the input, it will be noted as not available. This resource is intended for coding professionals, revenue cycle staff, and policy analysts seeking a national-level briefing on the clinical and billing profile of CPT code 38240.
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Billing Code Overview
CPT code 38240 describes the transfusion of hematopoietic progenitor cells (HPCs) harvested from a donor and introduced into the bloodstream of a recipient. This procedure represents donor-derived hematopoietic cell transplantation intended to reconstitute bone marrow function or immune capacity in the recipient.
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Service type: Cellular therapy / hematopoietic progenitor cell transplantation
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Typical site of service: Inpatient hospital or specialized transplant center, where blood-product infusion and post-infusion monitoring can be performed safely.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old recipient with relapsed acute myeloid leukemia receives an allogeneic hematopoietic progenitor cell transplant following conditioning chemotherapy. Donor cells were collected from a matched related donor and transported to the transplant center. On the day of infusion, the recipient is evaluated in the hematopoietic stem cell transplant unit, venous access is confirmed (central venous catheter), transfusion consent reviewed, premedications (acetaminophen, diphenhydramine, and corticosteroid as indicated) administered, and vital signs documented. The provider infuses donor-derived hematopoietic progenitor cells into the recipient intravenously under continuous monitoring for acute infusion reactions, with supportive orders standing for management of hypotension, allergic reaction, or cytokine release. Post-infusion monitoring continues for several hours with documentation of cell dose, donor identification, product lot number, and any adverse events. Typical site of service is an inpatient hospital transplant unit or an ambulatory infusion/transplant center depending on institutional protocol. Service type is an allogeneic hematopoietic progenitor cell infusion (transplant) procedure coded as 38240.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician's professional services distinct from technical services (rare for 38240). |
62 | Two surgeons | When two surgeons from different specialties perform distinct parts of the procedure. |
66 | Team surgeon | When multiple surgeons from the same specialty work as a team for portions of the transplant procedure. |
78 | Return to OR for related procedure during global period | When a return to the operating room is required for a related procedure during the global period. |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure occurs during the global period (note: not listed in input modifiers; not included). |
50 | Bilateral procedure | Not typically applicable to 38240; included only when bilateral notation would somehow apply (rare). |
51 | Multiple procedures | When multiple distinct procedures are reported on the same day in addition to 38240. |
52 | Reduced services | When the procedure is performed but less than typically required for full code reporting. |
53 | Discontinued procedure | When the infusion or procedure is started but discontinued for patient safety reasons. |
59 | Distinct procedural service | When a separate, distinct service is performed on the same day that is not usually reported together with 38240. |
62 | Two surgeons | When two surgeons perform distinct portions of the transplant procedure (repeated here as clinically relevant). |
76 | Repeat procedure by same physician | Not listed in input modifiers; not included. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare services for certain procedures in ambulatory surgical centers | When a qualifying non-physician practitioner performs covered portions of the service under Medicare rules. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208000000X | Hematology & Oncology | Hematologists/oncologists coordinate transplant indications, conditioning, and post-transplant care. |
| 2084P0800X | Transplant Surgery | Transplant surgeons or physicians responsible for procedural oversight of cell infusion and related surgical access. |
| 207RC0000X | Internal Medicine — Hematology | Hematology subspecialists manage donor selection, cell product evaluation, and engraftment follow-up. |
| 163W00000X | Pediatric Hematology-Oncology | When 38240 is performed in pediatric recipients; specialty manages pediatric-specific protocols. |
| 226E00000X | Clinical Laboratory | Laboratory medicine specialists oversee cell processing, compatibility testing, and product release. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C92.0 | Acute myeloblastic leukemia | Common indication for allogeneic hematopoietic progenitor cell transplantation to achieve remission or cure. |
C91.0 | Acute lymphoblastic leukemia | Indication for allogeneic HPC transplant in high-risk or relapsed disease. |
D46.9 | Myelodysplastic syndrome, unspecified | Progressive marrow failure often treated with allogeneic transplant. |
C81.9 | Hodgkin lymphoma, unspecified | Certain high-risk or relapsed lymphomas are indications for allogeneic transplant. |
C85.9 | Non-Hodgkin lymphoma, unspecified | Indication for autologous or allogeneic HPC transplantation depending on subtype and status. |
D70.9 | Neutropenia, unspecified | Post-transplant monitoring and management; neutropenia is corrected by successful engraftment. |
Z94.81 | Bone marrow transplant status | Used to denote a patient’s transplant status in follow-up care and billing contexts. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
38205 | Peripheral blood hematopoietic progenitor cell (HPC), apheresis; allogeneic transplant collection from donor | Donor collection procedure that precedes 38240 when peripheral blood stem cells are used. |
38206 | Peripheral blood hematopoietic progenitor cell (HPC), apheresis; autologous transplant collection from donor | Donor collection for autologous products; related when autologous grafts are infused instead of allogeneic. |
38241 | Transplantation of hematopoietic progenitor cells, allogeneic; cellular subset selection (eg, CD34 selection) | Laboratory or processing procedure performed on the graft prior to infusion to modify cellular composition. |
36415 | Collection of venous blood by venipuncture | Common ancillary service for pre-infusion testing and crossmatch specimens. |
36430 | Transfusion or infusion of blood products | Related infusion codes for supportive blood product administration that may occur before, during, or after 38240. |
36556 | Insertion of tunneled centrally inserted central venous catheter, with subcutaneous port or pump, without subcutaneous port | Vascular access procedures required for administration of HPCs in many transplant recipients. |