Summary & Overview
CPT 48554: Cadaveric Pancreas Allograft Implantation, Native Pancreas Retained
CPT code 48554 represents the surgical implantation of a cadaveric pancreas allograft while leaving the patient’s own pancreas in place. This operation is a form of solid-organ transplantation used for patients with pancreatic failure from trauma or chronic disease and is a high-acuity inpatient surgical service with significant perioperative and long-term care implications. Nationally, pancreas transplantation affects outcomes for select patients with end-stage pancreatic disease and interfaces with transplant center protocols, organ procurement systems, and payer authorization processes.
Key payers relevant to coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing context for 48554, including the service line and typical site of service, common payer coverage considerations, and the types of benchmarks and policy topics that typically accompany analysis of complex inpatient transplant procedures. The publication also summarizes common modifiers and administrative details that affect claim submission and discusses related clinical considerations such as indications and perioperative setting. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 48554 describes the implantation of a healthy pancreas from a cadaveric (nonliving) donor while leaving the recipient’s native pancreas in place. This procedure is performed for patients with pancreatic failure due to traumatic abdominal injury or chronic pancreatic disease.
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Service type: Surgical organ transplant procedure
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Typical site of service: Inpatient hospital setting, typically performed in an operating room with post-operative inpatient care
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with end-stage pancreatic insufficiency or traumatic pancreatic destruction who receives a whole-organ pancreatic allograft from a deceased donor while retaining their native pancreas. The patient often has brittle diabetes with recurrent hypoglycemia or life-threatening metabolic complications, chronic pancreatitis with intractable pain and malabsorption, or major pancreatic trauma. The clinical workflow begins with multidisciplinary evaluation by transplant surgery, endocrinology, and transplant nephrology when applicable; listing and donor matching; preoperative optimization including immunologic workup and infection screening; operative implantation of the cadaveric pancreas with vascular anastomoses and enteric or bladder drainage of the exocrine secretions; and immediate postoperative management in a transplant-capable intensive care unit with immunosuppression initiation, glycemic monitoring, infection surveillance, and complication management (bleeding, thrombosis, graft pancreatitis, or rejection). Hospital inpatient stay is typical, often with staged follow-up in transplant clinics for dose adjustments and surveillance biopsies or imaging if rejection or graft dysfunction is suspected.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rarely used; applies only when payer-specific use requires an unspecified modifier field. |