Summary & Overview
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).
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.
-
Service type: Cellular immunotherapy / adoptive lymphocyte transfer
-
Typical site of service: Hospital inpatient or outpatient specialty infusion center where transplant-related cellular therapies are administered
Data not available in the input.
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 |