Summary & Overview
CPT 38243: Donor-Derived Hematopoietic Progenitor Cell Infusion
CPT code 38243 denotes infusion of hematopoietic progenitor cells (HPCs) when the infused cells are from the same donor whose cells the patient previously received in an HPC transplant. This procedure is clinically significant for patients requiring supplemental or repeat donor-derived cell infusions to restore or augment hematopoiesis after transplant-related complications or graft failure. Nationally, the code captures a specialized transplant service that impacts utilization, resource planning, and coverage policies across commercial and public payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for donor-derived HPC infusion, expected sites of service, and the service line classification. The publication provides benchmarking details where available, summarizes common billing considerations and modifiers, and highlights relevant policy and reimbursement issues affecting access to repeat donor-derived HPC infusions. The content is designed to inform coding professionals, transplant program administrators, and payers about the clinical and billing contours of CPT code 38243 and what to consider when reviewing claims or developing coverage guidance.
Billing Code Overview
CPT code 38243 describes the infusion of hematopoietic progenitor cells (HPCs) into a patient when the cells are from the same transplant donor whose cells the patient previously received during an HPC transplant. This procedure represents a targeted cellular infusion intended to administer donor-derived progenitor cells back into a recipient to support hematopoietic function.
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Service type: Therapeutic cellular infusion
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Typical site of service: Inpatient hospital or specialized outpatient infusion/transplant center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric recipient of an allogeneic hematopoietic progenitor cell (HPC) transplant who requires infusion of additional HPCs from the same donor as part of a planned boost, rescue for poor graft function, or management of graft failure. The patient usually presents in an inpatient transplant unit or specialized outpatient infusion center after prior conditioning and transplant. Pre-infusion steps include verification of donor identity and prior transplant records, confirmation of cell product compatibility and chain-of-custody, baseline vital signs and lab evaluation (CBC, coagulation, infectious disease testing), informed consent review, and IV access placement. The procedure consists of retrieving the thawed or fresh HPC product, performing bedside checks with the transplant physician and nursing team, and infusing the product via central venous catheter under monitoring for infusion reactions. Post-infusion care includes observation for acute infusion-related events (fever, hypotension, allergic reaction), serial CBCs to assess engraftment, supportive care, and documentation of product lot numbers and cell dose. Typical sites of service are inpatient bone marrow transplant units, hospital outpatient infusion centers, or specialized ambulatory transplant clinics. Common clinical indications include poor graft function after allogeneic transplant, primary or secondary graft failure, and planned donor lymphocyte or HPC boost following hematologic malignancy treatment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default professional and technical components intact |