CPT 44135 Small Bowel Transplant Reimbursement | OpenPayer

Summary & Overview

CPT 44135: Small Bowel Transplant with Cadaver Donor Intestine

CPT code 44135 represents a complex surgical transplant procedure in which the affected segment of a recipient’s small intestine is transected and reconstituted using cadaver donor intestine. This code captures an advanced reconstructive intestinal transplant performed in an operating room or inpatient hospital setting and is relevant to tertiary care centers, transplant programs, and insurers managing high-cost, high-acuity surgical care.

Key payers included in this national analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines what CPT code 44135 denotes clinically, where and by whom the service is typically provided, and which payers commonly cover such procedures.

Readers will find concise benchmarks and contextual information on utilization and billing practices, an overview of payer coverage considerations, and clinical context for when this procedure is indicated. The content is intended to inform billing staff, revenue cycle managers, transplant program administrators, and policy analysts about the code’s clinical meaning, service setting, and the payer landscape. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 44135small bowel transplantintestinal reconstructionsurgical transplantinpatient surgerytransplant surgeryhospital billingreconstructive surgery

Billing Code Overview

CPT code 44135 describes a surgical procedure in which the provider transects the affected portion of a recipient’s small bowel and uses a cadaver donor intestine to reconnect the recipient’s intestinal ends. This procedure involves removing or excluding a diseased segment of small intestine and performing an intestinal transplant reconstruction using donor intestinal tissue.

Service type: Surgical transplant/reconstructive procedure involving the small intestine
Typical site of service: Operating room or inpatient hospital surgical suite

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with irreversible short bowel syndrome or focal small bowel necrosis who is undergoing intestinal transplantation using a cadaveric donor segment. The patient often presents after multiple prior abdominal surgeries, chronic intestinal failure with dependence on parenteral nutrition, malnutrition, recurrent sepsis, or ischemic injury to a segment of small intestine. Preoperative workup includes multidisciplinary evaluation by transplant surgery, gastroenterology, infectious disease, and nutrition, crossmatch and immunology testing, CT angiography of mesenteric vessels, and optimization of fluid and electrolyte status.

The clinical workflow begins with donor organ allocation and recipient preparation in the operating room. Under general endotracheal anesthesia, the surgeon transects the diseased portion of the recipient’s small bowel, removes the nonviable segment, and implants the cadaveric donor intestine to reconstruct continuity. Vascular anastomoses and enteric anastomoses are created, hemostasis ensured, and abdominal closure performed with drains as indicated. Postoperative care occurs in an intensive care or specialized transplant unit with immunosuppressive therapy initiation, graft monitoring, nutritional support (often advancing from parenteral to enteral feeds), prophylactic antimicrobials, and serial imaging or endoscopy as clinically indicated. Typical sites of service include the operating room for the transplant procedure and the inpatient hospital setting for pre- and post-operative care.

Coding Specifications

Modifier	Description	When to Use
`00`

CPT 44150: Total Colectomy with Ileostomy or Ileorectal Anastomosis

CPT-44145-PARTIAL-COLECTOMY-COLORECTAL-ANASTOMOSIS

CPT 44145: Partial Colectomy with Colorectal Anastomosis

CPT-44100-SMALL-INTESTINE-CAPSULE-BIOPSY

CPT 44100: Small Intestine Biopsy via Oral Capsule

CPT-44147-COLON-RESECTION-OPEN-ABDOMINAL-AND-ANAL-APPROACH

CPT 44147: Colon Resection, Open Abdominal and Anal Approach

CPT-44151-TOTAL-COLECTOMY-ILEAL-POUCH-CONTINENT-ILEOSTOMY

CPT 44151: Total Colectomy with Ileal Pouch and Continent Ileostomy

CPT-44139-SPLENIC-FLEXURE-MOBILIZATION-DURING-COLECTOMY

CPT 44139: Splenic Flexure Mobilization During Colectomy

CPT-44141-COLON-RESECTION-WITH-CECOSTOMY-OR-COLOSTOMY

CPT 44141: Colon Resection with Skin-Level Cecostomy or Colostomy

CPT-44111-INTESTINAL-LESION-EXCISION-MULTIPLE-INCISIONS

CPT 44111: Excision of Intestinal Lesions, Multiple Incisions

CPT-44144-COLON-RESECTION-WITH-COLOSTOMY-AND-MUCOUS-FISTULA

CPT 44144: Colon Resection with Colostomy and Mucous Fistula

CPT-44146-LOW-ANTERIOR-RESECTION-WITH-COLOSTOMY

CPT 44146: Low Anterior Resection with Colostomy

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Taxonomy Code	Specialty	Notes
208100000X	General Surgery	Transplant surgeons often have general surgery background and perform intestinal transplants
2080P0206X	Transplant Surgery	Specialized transplant surgeons who perform multivisceral and isolated intestinal transplants
208800000X	Gastroenterology	Gastroenterologists manage pre/post transplant nutrition and bowel function
207L00000X	Critical Care Medicine	Intensivists manage perioperative ICU care for transplant recipients
363L00000X	Clinical Transplant Immunology (Consulting)	Immunologists or transplant pharmacists involved in immunosuppression planning

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K91.83`	Short bowel syndrome (postprocedural)	Common indication for intestinal transplantation when irreversible intestinal failure exists
`K55.9`	Vascular disorder of intestine, unspecified	Mesenteric ischemia or vascular compromise may necessitate resection and transplantation
`K57.50`	Diverticulitis of large intestine with perforation and abscess without bleeding	Complicated intra-abdominal infection leading to loss of bowel segments in complex cases (relevance when multivisceral disease present)
`K65.9`	Peritonitis, unspecified	Severe or recurrent peritonitis can render segments nonviable and drive need for transplant
`T81.3XXA`	Disruption of surgical wound, initial encounter	Postoperative complications that may lead to additional operative interventions involving the graft
`Z94.1`	Transplanted organ status, intestinal	Used in postoperative follow-up to indicate intestinal transplant recipient status
`B95.61`	Methicillin susceptible Staphylococcus aureus as the cause of diseases classified elsewhere	Infection is a common perioperative concern influencing transplant candidacy and management

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44135`	Transection of recipient small bowel and interposition of cadaver donor intestine (intestinal transplant)	Primary procedure described — reconstruction of intestinal continuity using cadaveric donor intestine
`32855`	Organ procurement, intestinal allograft (separate procedure)	Performed by procurement team to recover donor intestine prior to implantation
`36831`	Arterial anastomosis, vascular transplant (e.g., vascular reconstruction)	Vascular anastomoses performed during transplant to restore blood flow to the donor intestine
`44140`	Colectomy, partial; with anastomosis	May be performed if combined resection of colon is required during multivisceral procedures
`44227`	Laparoscopy, surgical; colectomy, partial	Minimally invasive techniques may be used for adjunctive procedures when applicable
`49505`	Repair recurrent incisional hernia, with or without mesh	Possible subsequent procedure for abdominal wall closure issues or hernia repair after transplant

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