CPT 38241: Autologous Hematopoietic Progenitor Cell Reinfusion
CPT code 38241 denotes autologous hematopoietic progenitor cell (HPC) reinfusion, a procedure in which a patient’s own harvested progenitor cells are introduced into the bloodstream to restore bone marrow function. This procedure is clinically important for patients undergoing high-dose chemotherapy or other myeloablative therapies and has national relevance given its role in oncology and hematology care pathways.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context, typical sites of service, and the operational implications of billing for autologous HPC reinfusion. The publication summarizes common billing considerations, typical modifier usage where relevant, and how CPT code 38241 fits into the broader set of hematopoietic cell transplantation services.
The report provides national benchmarks and practical billing context, highlights policy and coverage considerations that affect access and reimbursement, and outlines the clinical scenarios in which CPT code 38241 is most commonly used. Data not available in the input will be noted where necessary.
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Billing Code Overview
CPT code 38241 describes a procedure in which the provider introduces into a patient’s bloodstream hematopoietic progenitor cells (HPCs) that were harvested directly from the same patient. This procedure is a form of autologous hematopoietic cell transplantation where a patient’s own progenitor cells are reinfused to reestablish hematopoiesis following preparative therapy.
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Service type: Autologous hematopoietic progenitor cell reinfusion
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Typical site of service: Hospital inpatient or outpatient infusion center, depending on clinical status and institutional protocol
Clinical & Coding Specifications
Clinical Context
A typical patient is a 25–50-year-old adult undergoing autologous hematopoietic progenitor cell (HPC) infusion, where the provider reintroduces hematopoietic progenitor cells harvested previously from the same patient into the patient’s bloodstream. Common indications include hematologic malignancies (for example, relapsed lymphoma or multiple myeloma) following myeloablative or reduced-intensity conditioning, or recovery of bone marrow function after high-dose chemotherapy. The clinical workflow includes: pre-procedure evaluation (confirm cell product identity, infectious disease testing, crossmatch if indicated, and review of conditioning regimen timing), vascular access assessment (existing central venous catheter or placement), intravenous infusion of the HPC product under monitored conditions with vital sign and transfusion-reaction surveillance, post-infusion observation for immediate reactions, and coordination with the transplant team for inpatient monitoring of engraftment and supportive care. Typical site of service is an inpatient transplant unit or an ambulatory transplant infusion center depending on conditioning and institutional protocol. The service type is an autologous hematopoietic progenitor cell infusion derived from the patient’s own previously harvested cells.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard; no modifier required by payer | Rarely used as an explicit modifier; default billing when payer requires two-character code for no additional modifiers |
11 | Professional component | When a separate professional interpretation or component is billed by a physician for services associated with the procedure |
22 | Increased procedural services | When the infusion required substantially greater effort, time, or complexity than typical |
23 | Unusual anesthesia | When anesthesia for the procedure is medically necessary and more than minor or local anesthesia is required |
26 | Professional component | When the physician bills only the professional component of a service related to the procedure |
52 | Reduced services | If the infusion was partially reduced or not completed as planned |
53 | Discontinued procedure | When the infusion was started but terminated due to patient instability or adverse reaction |
59 | Distinct procedural service | When the infusion is distinct from other services performed on the same day (e.g., separate surgical access) |
62 | Two surgeons | When two surgeons with distinct roles perform the procedure (rare for infusion but applicable if surgical access is created by another surgeon) |
76 | Repeat procedure by same physician | (Note: not in list provided) Data not available in the input. |
78 | Unplanned return to the operating/procedure room | If patient requires immediate return for management of a complication related to the infusion |
80 | Assistant surgeon | When an assistant surgeon is required for vascular access or operative components |
81 | Minimum assistant surgeon | When minimal assistant involvement occurred |
TC | Technical component | When billing only technical component for facility resources used in the infusion |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080S0004X | Hematology/Oncology | Physicians who direct transplant and HPC infusion procedures |
208000000X | Medical Oncology | Oncologists managing conditioning and autologous infusion protocols |
2084P0800X | Bone Marrow Transplant Specialist | Providers specializing in hematopoietic stem cell transplantation |
363L00000X | Transfusion Medicine Specialist | Physicians overseeing cellular therapy product handling and infusion |
207L00000X | Internal Medicine | Hospitalist or inpatient physicians providing peri-procedural care |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C90.00 | Multiple myeloma not having achieved remission | Common indication for autologous HPC infusion after high-dose chemotherapy |
C85.90 | Non-Hodgkin lymphoma, unspecified, without mention of in remission | Indication for autologous transplant and subsequent HPC reinfusion |
C81.90 | Hodgkin lymphoma, unspecified, without mention of in remission | Indication for high-dose therapy and autologous stem cell support |
D61.0 | Drug-induced aplastic anemia | Indication for HPC infusion to restore marrow function after marrow failure or myeloablative therapy |
Z92.21 | Bone marrow transplant status | Used to indicate history/status of bone marrow transplant in the medical record and claims |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
38240 | Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor | Works as the allogeneic counterpart to 38241; used when donor-derived cells are infused instead of autologous cells |
38242 | Hematopoietic progenitor cell (HPC); collection from a donor for transplantation | Performed before infusion when cells are collected from a donor; relevant in the broader transplant workflow |
36556 | Collection of blood specimen from a central venous catheter, percutaneous, without subcutaneous port | May be used for product sampling or pre-infusion testing related to vascular access |
36561 | Insertion of tunneled centrally inserted central venous catheter, with cuff | Often performed prior to HPC infusion to provide long-term vascular access for infusion and supportive care |
86816 | Crossmatch test, each unit; compatibility testing for transplantation | Used for compatibility testing or infectious disease/product testing associated with cellular therapy |
36569 | Replacement, removal and reinsertion of central venous catheter, without subcutaneous port | Performed if existing vascular access is inadequate and must be revised before infusion |