Summary & Overview
CPT 48160: Pancreatectomy with Pancreatic Tissue or Islet Transplant
CPT code 48160 covers surgical removal of part or all of the pancreas with harvesting and transplantation of pancreatic tissue or islet cells, generally implanted in the abdominal tissue. This code matters nationally because pancreatic tissue and islet transplantation are specialized, high-cost procedures that intersect transplant policy, organ procurement rules, and coverage determinations for metabolic and endocrine conditions.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Coverage and prior authorization requirements vary across commercial plans and Medicare policies, which affects access, site-of-service decisions, and claim adjudication for complex surgical-transplant episodes.
Readers will find a concise overview of clinical context, expected site-of-service, and common billing practice for this procedure. The publication outlines typical payer considerations, common modifiers reported with the service, and where to look for policy updates. Benchmarks and payer-specific coverage policy details are summarized where available. Data not available in the input is noted explicitly for missing items such as associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 48160 describes removal of the entire or part of the affected pancreas with harvesting and transplantation of pancreatic tissue or islet cells, typically into the recipient's abdominal tissue. This procedure involves resection of pancreatic tissue followed by processing and implantation of islets or pancreatic fragments for metabolic or grafting purposes.
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Service type: Surgical procedure involving organ resection and autologous or allogeneic pancreatic tissue/islet transplantation
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Typical site of service: Inpatient hospital operating room with subsequent inpatient recovery and monitoring
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient with brittle type 1 diabetes and recurrent severe hypoglycemic events undergoes pancreatectomy with islet autotransplantation. The patient is evaluated by a multidisciplinary team including transplant surgery, endocrinology, and anesthesia. Preoperative workup includes metabolic stabilization, imaging to assess pancreatic anatomy, infectious disease screening, and discussion of risks and benefits. In the operating room, the surgeon performs removal of the diseased pancreas (total or partial), harvests pancreatic tissue and isolates islet cells in a specialized laboratory, then transplants islets typically into the hepatic portal vein or into abdominal tissue depending on protocol. Postoperative care involves intensive monitoring for graft function, glucose management with insulin or other agents, anticoagulation as indicated, and surveillance for surgical complications such as bleeding, infection, or portal vein thrombosis. Follow-up includes serial measurement of C-peptide, hemoglobin A1c, and adjustments to diabetes therapy based on islet function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — primary procedure code used as billed | When no special circumstances apply and the procedure is reported without modification |
22 |