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.
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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 | Rarely appended; indicates standard reporting when no other modifier applies |
11 | Normal or routine services | To indicate a typical, uncomplicated infusion event when allowed by payer |
22 | Increased procedural services | When the infusion required substantially greater services (e.g., prolonged monitoring for severe reactions) and documentation supports increased complexity |
23 | Unusual anesthesia | If unusual anesthesia unrelated to the procedure was required (rare for infusion, used only if applicable) |
50 | Bilateral procedure | Not commonly applicable; included when a payer requires a bilateral indicator (generally not used for HPC infusion) |
52 | Reduced services | When the infusion was partially performed or truncated due to clinical reasons (e.g., product withheld) |
53 | Discontinued procedure | If infusion was initiated but discontinued for safety reasons prior to completion |
62 | Two surgeons | If two physicians of the same specialty are required for the procedure (rare for infusion) |
73 | Discontinued outpatient procedure prior to anesthesia | If planned outpatient infusion was cancelled after patient preparation but before start (billing rules dependent) |
78 | Return to OR for a related procedure during global period | If a related operative procedure occurs and affects global billing (rarely applicable) |
80 | Assistant at surgery | If an assistant surgeon is legitimately required and documented (rare for infusion procedures) |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services in lieu of physician | When a qualified non-physician practitioner performs reportable portions of the infusion under state scope of practice and payer rules |
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Rarely applies; included only if anesthesia services are billed in conjunction with infusion and medical direction meets criteria |
TC | Technical component only | If only the technical component is billed by a facility (billing depends on payer and setting) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080P0207X | Hematology & Oncology | Physicians who direct transplant programs and order HPC boosts |
208000000X | Hematology | Specialists managing engraftment and graft failure issues |
207RC0000X | Adult Transplant Hepatology (representing transplant specialty) | Facility or team members involved in transplant care workflows |
274N00000X | Registered Nurse (RN) | Nurses who perform product checks and infusion monitoring in transplant units |
367A00000X | Clinical Laboratory Technologist | Laboratory specialists involved in cell product testing and release |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D61.81 | Transplantation related graft-versus-host disease (GVHD) | GVHD is a key post-transplant complication influencing decisions about additional HPC infusions or cellular therapies |
T86.00 | Complications of bone marrow transplant, unspecified | General code for complications after transplant that may prompt additional HPC infusions |
D61.29 | Other aplastic anemias | Severe marrow failure may be an indication for HPC infusion or repeat transplant procedures |
C92.0 | Acute myelogenous leukemia | A common hematologic malignancy for which allogeneic HPC transplant and subsequent boosts may be indicated |
C91.1 | Chronic lymphocytic leukemia | Hematologic malignancy treated with transplant in select cases; related to transplant workflows |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
38240 | Bone marrow transplantation, allogeneic; without stem cell harvesting | Related prior procedure when the patient previously received an allogeneic transplant from the same donor |
38241 | Bone marrow transplantation, allogeneic; with stem cell harvesting from donor and mar | Represents donor collection procedures that precede HPC infusion in donor-related transplants |
36556 | Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older | Commonly performed pre-procedure to provide secure central access for HPC infusion |
36415 | Collection of venous blood by venipuncture | Performed for pre-infusion testing, crossmatch, and infectious disease assays |
99024 | Postoperative follow-up visit during global period | Used for subsequent transplant follow-up visits documenting engraftment and complications |