Summary & Overview
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.
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.
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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 ). |