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    v1.0.30
    OpenPayerBilling CodesLiver Transplantation ProceduresCPT cpt-47146-liver-graft-vein-graft-attachment
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    CPT 47146: Vein Graft to Liver Graft Vein Segment

    Medicare pays $295 on average nationally for this procedure.

    CPT code 47146 describes a surgical transplant technique in which the provider attaches a vein graft to a vein segment on a liver graft to create a single vein of adequate length for anastomosis to the recipient’s vein; this procedure is a vascular reconstruction performed as part of liver transplant graft preparation and is typically provided in an inpatient operating room or transplant surgical suite setting.

    For related coverage guidance, see recent payer policy updates: Hematology - Adzynma, Tumor Treating Fields for Pancreatic Cancer, Axicabtagene ciloleucel (Yescarta®) coverage.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 45–65-year-old adult undergoing orthotopic liver transplantation for end-stage liver disease (for example, cirrhosis from hepatitis C or alcohol-related liver disease). During back-table preparation of the donor liver graft, the transplant surgeon identifies that the donor hepatic venous outflow requires reconstruction to provide a single, adequately long venous conduit for anastomosis to the recipient's vena cava or hepatic vein. The surgeon harvests an autologous or allogeneic vein graft (such as an iliac vein or donor portal vein segment) and attaches it to a segment of the donor liver graft vein to create a single cuff or conduit.

    The clinical workflow includes preoperative planning by the transplant team, donor organ procurement, back-table bench surgery where 47146 is performed to fashion the venous outflow, transportation of the reconstructed graft to the operating room, and implantation with vascular anastomoses to recipient vessels. Intraoperative vascular assessment (patency and length) follows the reconstruction, and the transplant is completed with standard biliary and arterial anastomoses. Postoperatively, the patient is monitored in the intensive care unit for hemodynamic stability and graft function, with imaging surveillance (Doppler ultrasound, CT) to evaluate venous outflow.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    47135Preparation of donor liver, hepatic artery reconstruction, and portal vein reconstruction (bench)Performed on the back table during donor graft preparation; may be billed alongside venous reconstruction when multiple vascular reconstructions are done
    47140Hepatic autotransplantation, including vascular reconstructionRelated complex hepatic vascular procedures; represents similar bench and vascular work during transplant situations
    47150Implantation of liver, includes recipient hepatectomy and vascular and biliary anastomosesPerformed after 47146 when the prepared donor graft is implanted into the recipient; complementary in the transplant workflow
    35331Vein graft, autogenous vein, with anastomosis (used in peripheral vascular procedures)Represents venous graft techniques and supplies context for vein conduit use though not specific to hepatic bench work
    34820Intraoperative monitoring of vascular grafts (angiography, etc.)Imaging or intraoperative assessment codes that may be used to document patency checks after the reconstruction

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0201X
    207L00000X
    207K00000X
    207R00000X
    2865C1500X
    246QH0000X
    173F00000X
    225XN1300X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    B16.9Acute hepatitis B without delta-agent and without hepatic coma
    B18.2Chronic viral hepatitis C
    C22.0Liver cell carcinoma
    C22.9Malignant neoplasm of liver, not specified as primary or secondary
    I82.403Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral
    I82.409Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity
    I82.891Chronic embolism and thrombosis of other specified veins
    I85.01Esophageal varices with bleeding
    I85.11Secondary esophageal varices with bleeding
    K70.30Alcoholic cirrhosis of liver without ascites

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Hematology - AdzynmaCigna2026-10-15
    Tumor Treating Fields for Pancreatic Cancerselect_health2026-10-01
    Axicabtagene ciloleucel (Yescarta®) coverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Kentucky Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Kansas Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Idaho Only)UnitedHealthcare2026-10-01
    Brexucabtagene autoleucel (Tecartus) CoverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Pennsylvania Only)UnitedHealthcare2026-10-01
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Factor VIII ProductsCigna2026-09-15

    Related Codes

    CPT-47133-DONOR-HEPATECTOMY-DONOR-LIVER-PROCUREMENT

    CPT 47133: Donor Hepatectomy, Cadaver Liver Resection

    CPT-47135-LIVER-ALLOTRANSPLANTATION

    CPT 47135: Liver Allotransplantation

    CPT-47140-DONOR-HEPATECTOMY-LEFT-LATERAL-SEGMENTS

    CPT 47140: Donor Left Lateral Segment Hepatectomy

    CPT-47141-DONOR-HEPATECTOMY-LEFT-LOBE-RESECTION

    CPT 47141: Donor Hepatectomy, Left Lobe Resection

    CPT-47142-RIGHT-LOBE-LIVING-DONOR-HEPATECTOMY-FOR-TRANSPLANT

    CPT 47142: Living-Donor Right Lobe Hepatectomy

    CPT-47143-BACKBENCH-LIVER-PREPARATION-CADAVER-DONOR

    CPT 47143: Donor Liver Backbench Standard Preparation

    CPT-47144-BACKBENCH-LIVER-PREPARATION-FOR-TRANSPLANT

    CPT 47144: Backbench Liver Preparation for Two Allografts

    CPT-47145-BACKBENCH-LIVER-PREPARATION-CADAVER-DONOR

    CPT 47145: Backbench Liver Preparation for Split Allografts

    CPT-47147-LIVER-GRAFT-ARTERY-GRAFT-FOR-ANASTOMOSIS

    CPT 47147: Artery Graft to Liver Graft Arterial Segment

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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