38240

Hematopoietic progenitor cell (HPC) allogeneic transplantation; cellular infusion only

CPT code 38240 describes the intravenous infusion of hematopoietic progenitor cells (HPCs) obtained from an allogeneic (genetically different) donor. This procedure is typically performed following a high-dose conditioning regimen (e.g., chemotherapy, radiation therapy) designed to suppress or ablate the recipient's bone marrow and immune system. The goal of the infusion is to reconstitute the patient's hematopoietic and immune systems with healthy donor cells, thereby treating various hematologic malignancies, bone marrow failure syndromes, genetic disorders, or immunodeficiencies. This code specifically covers the act of infusing the prepared allogeneic HPC product into the patient, but does not include donor procurement, cell processing, or the pre-transplant conditioning regimen.

Clinical Indications

  • Acute myeloid leukemia (AML) in remission or with high-risk features
  • Acute lymphoblastic leukemia (ALL) in remission or with high-risk features
  • Myelodysplastic syndromes (MDS) with high-risk features or progression to AML
  • Severe aplastic anemia unresponsive to immunosuppressive therapy
  • Chronic myeloid leukemia (CML) in advanced phases or refractory to tyrosine kinase inhibitors
  • High-risk lymphomas (e.g., Hodgkin lymphoma, non-Hodgkin lymphoma) in relapsed or refractory settings after initial therapies
  • Multiple myeloma in select high-risk cases or clinical trials
  • Severe combined immunodeficiency (SCID) and other primary immunodeficiency disorders
  • Thalassemia major (beta-thalassemia) to achieve curative treatment
  • Sickle cell disease (SCD) with severe complications or high-risk features

Procedure Steps

  1. Confirm patient identity, eligibility, and completion of pre-infusion conditioning regimen.
  2. Ensure secure central venous access (e.g., central venous catheter, PICC line).
  3. Retrieve and verify the allogeneic HPC product from the cell processing laboratory, confirming donor-recipient match and product integrity.
  4. If cryopreserved, rapidly thaw the HPC product at the patient's bedside according to established protocols.
  5. Infuse the thawed or fresh HPC product intravenously, typically via gravity or an infusion pump, at a controlled rate.
  6. Monitor the patient closely throughout the infusion for immediate adverse reactions (e.g., allergic reactions, dyspnea, hypotension, hypertension, chills, fever, nausea, vomiting, or reactions to cryoprotectants like DMSO).
  7. Administer supportive medications as needed for managing infusion-related reactions.
  8. Document the infusion details, including product identifiers, volume, infusion start and end times, patient vital signs, and any reactions or interventions.

Coding Guidelines

  • Code 38240 represents the cellular infusion only and does not include services related to donor cell procurement (e.g., bone marrow harvest, apheresis), cell processing (e.g., manipulation, cryopreservation), or the pre-transplant conditioning regimen (e.g., chemotherapy, radiation).
  • Services related to the donor (e.g., donor evaluation, harvest) are billed separately under appropriate donor codes.
  • Cell processing and manipulation codes (e.g., 38205-38215) may be billed separately if performed by the same entity on the same date of service.
  • Pre-transplant evaluation and post-transplant management are reported with appropriate Evaluation and Management (E/M) codes, hospital inpatient codes, or other relevant services.
  • This code typically has a global period of 0 or 10 days, meaning significant separate E/M services may be billed during the inpatient stay or follow-up period.
  • Documentation must clearly specify the allogeneic source of the hematopoietic progenitor cells and the date of infusion.
  • Typically billed once per transplant episode, regardless of the number of bags or aliquots infused as part of a single allogeneic transplant event.
  • When reporting for Medicare beneficiaries, ensure that the transplant program is Medicare-approved and that the indications for transplant are covered.

Associated ICD-10 Codes