CPT 38242: Donor Lymphocyte Infusion for Post-Transplant Immune Support
CPT code 38242 represents adoptive transfer of donor lymphocytes into a recipient’s bloodstream, a specialized cellular immunotherapy used for patients with recurrent infections or lymphoproliferative disease after transplantation. Nationally, this procedure is significant because it addresses post-transplant immune complications and can impact hospital resource use, specialty infusion services, and transplant program care pathways.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise overview of the clinical context for 38242, typical settings where the service is delivered, and the types of benchmarks and policy considerations relevant to reimbursement and coverage for transplant-related cellular therapies. The publication outlines national-level benchmarks where available, summarizes payer coverage themes, and highlights clinical and coding points that affect billing for adoptive lymphocyte transfer.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a focused briefing on the clinical purpose of CPT code 38242, the major payers engaged in coverage decisions, and the categories of information covered in the full publication (benchmarking, policy updates, and clinical context).
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Billing Code Overview
CPT code 38242 describes a therapeutic procedure in which lymphocytes harvested from a donor are introduced into the bloodstream of a recipient. This service is provided for patients with recurrent infections or lymphoproliferative disease related to transplantation and is intended to restore or augment immune function through adoptive transfer of donor lymphocytes.
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Service type: Cellular immunotherapy / adoptive lymphocyte transfer
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Typical site of service: Hospital inpatient or outpatient specialty infusion center where transplant-related cellular therapies are administered
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Clinical & Coding Specifications
Clinical Context
A 45-year-old patient with profound lymphopenia and recurrent opportunistic infections following an allogeneic hematopoietic stem cell transplant is evaluated for adoptive lymphocyte transfer. The transplant team identifies a matched donor (usually the original stem cell donor or a closely matched related donor) who undergoes lymphocyte harvest. The procedure 38242 documents the infusion of lymphocytes from that donor into the recipient to provide passive cellular immunity and treat or prevent persistent viral or fungal infections or post-transplant lymphoproliferative disease. The workflow includes donor screening and consent, donor peripheral blood lymphocyte collection (apheresis or venipuncture harvest documented separately), infectious disease and HLA compatibility testing, pre-infusion recipient assessment, administration of pre-medications as indicated, infusion of harvested lymphocytes under monitored conditions in an outpatient infusion center or inpatient transplant unit, and post-infusion observation for infusion reactions and graft-versus-host phenomena. Documentation should include donor identification, harvest method, cell dose or volume infused, time and date of infusion, recipient pre- and post-infusion vital signs, and any adverse events.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Provider's usual service | When reporting the service by the primary performing clinician |
22 | Increased procedural services | For substantially greater work or time than typical for 38242 |
52 | Reduced services | If the lymphocyte infusion was partially performed or truncated |
53 | Discontinued procedure | If infusion begun but stopped due to adverse event |
59 | Distinct procedural service | When an unrelated procedure is performed on the same day and must be distinguished |
62 | Two surgeons | Rare; when two surgeons of different specialties share responsibility for the procedure |
76 | Repeat procedure by same physician | If the same physician repeats the infusion later same day |
77 | Repeat procedure by another physician | If a different physician repeats the infusion same day |
78 | Unplanned return to the OR/procedure room | If unplanned return for management of infusion complication occurs |
79 | Unrelated procedure by same physician during postoperative period | To indicate a separate unrelated procedure |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080S0005X | Hematology | Hematologists direct transplant-related cellular therapies |
207RC0000X | Transplant Surgery | Transplant surgeons coordinate peri-transplant procedures and infusions |
208000000X | Oncology | Medical oncologists manage malignant and post-transplant lymphoproliferative disease |
2084P0800X | Infectious Disease | Infectious disease specialists manage opportunistic infections and donor selection |
3336A0400X | Clinical Laboratory Specialist | Laboratory specialists oversee cell processing and infectious testing |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D84.9 | Immunodeficiency, unspecified | Underlying immune deficiency prompting adoptive lymphocyte therapy for recurrent infections |
D80.9 | Immunodeficiency with predominantly antibody defect, unspecified | Patients with combined immune defects may receive lymphocyte infusions to augment cellular immunity |
D47.Z9 | Neoplasm of uncertain behaviour of lymphoid, hematopoietic and related tissue, unspecified | Lymphoproliferative disorders post-transplant that may be treated or controlled with donor lymphocytes |
T86.10 | Complications of bone marrow transplant, unspecified | Post-transplant complications including infections or graft failure leading to need for lymphocyte transfer |
B20 | Human immunodeficiency virus [HIV] disease | Severe, treatment-refractory opportunistic infections in immunocompromised patients may prompt cellular therapy (rare) |
J18.9 | Pneumonia, unspecified organism | Recurrent severe infections such as pneumonia in an immunocompromised host that may prompt adoptive lymphocyte transfer |
A49.9 | Bacterial infection, unspecified | Persistent, recurrent bacterial infections despite standard therapy where immune augmentation is considered |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
38240 | Hematopoietic progenitor cell (HPC), autologous; allogeneic peripheral blood progenitor cell collection or exchange transfusion | Often performed earlier for donor cell harvest when mobilized peripheral blood stem cells are collected prior to lymphocyte isolation |
38241 | Hematopoietic progenitor cell (HPC), allogeneic; bone marrow harvest for transplantation | Alternative donor cell source; may be performed instead of peripheral harvest |
86356 | Crossmatch, antibody detection (e.g., lymphocyte crossmatch) | Pre-infusion laboratory compatibility testing between donor lymphocytes and recipient |
36415 | Collection of venous blood by venipuncture | Documentation of peripheral blood draws for infectious disease and compatibility testing prior to infusion |
96365 | Intravenous infusion, initial, up to 1 hour | When infusion time and administration are billed for time-based infusion services associated with lymphocyte administration |