Request for transplant or transplant-related services prior to pre-treatment or evaluation,including the following CPT Procedure Codes for Specifically Requested Transplantations:
BONE MARROW - Peripheral Stem Cell
38230 Bone marrow harvesting for transplantation
38240 Bone marrow or blood-derived peripheral stem cell transplantation; allogenic
38241 Bone marrow or blood-derived peripheral stem cell transplantation; autologous
38242 Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic donor
lymphocyte infusions
HEART / LUNG
33930 D onor cardiectomy-pneumonectomy, with preparation and maintenance of allograft
33935 Heart-lung transplant with recipient cardiectomy-pneumonectomy HEART
33940 D onor cardiectomy, with preparation and maintenance of allograft
33945 Heart transplant, with or without recipient cardiectomy
0051T I mplantation of a total replacement heart system (artificial heart) with recipient cardiectomy
0052T Replacement or repair of thoracic unit of a total replacement heart system (artificial heart)
0053T Replacement or repair of implantable component or components of total replacement heart system (artificial heart), excluding thoracic unit
LUNG
32850 D onor pneumonectomy(ies) with preparation and maintenance of allograft (cadaver)
32851 L ung transplant, single; without cardiopulmonary bypass
32852 with cardiopulmonary bypass
32853 L ung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass
32854 with cardiopulmonary bypass
KIDNEY
50300 D onor nephrectomy, with preparation and maintenance of allograft, from cadaver donor,
unilateral or bilateral
50320 D onor nephrectomy, open from living donor (excluding preparation and maintenance of
allograft)
50340 Recipient nephrectomy
50360 Renal allotransplantation, implantation of graft; excluding donor and recipient nephrectomy
50365 with recipient nephrectomy
50370 Removal of transplanted renal allograft
50380 Renal autotransplantation, reimplantation of kidney
50547 L aparoscopic donor nephrectomy from living donor (excluding preparation and maintenance of allograft)
PANCREAS
48160 Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or pancreatic islet cells
48550 D onor pancreatectomy, with preparation and maintenance of allograft from cadaver donor, with or without duodenal segment for transplantation
48554 Transplantation of pancreatic allograft
48556 Removal of transplanted pancreatic allograft
LIVER
47135 L iver allotransplantation; orthotopic, partial or whole, from cadaver or living donor, any age
47136 heterotopic, partial or whole, from cadaver or living donor, any age
INTESTINE
44132 D onor enterectomy, open, with preparation and maintenance of allograft; from cadaver donor
44133 partial, from living donor
44135 I ntestinal allotransplantation; from cadaver donor
44136 from living donor
Colonoscopy with stool transplant CPT code 44705
There is no specific code to bill Colonoscopy with Stool transplant. We can use Fecal Microbiita Transplant code instead of Colonoscopy with stoll transplant code.
Coding and billing FMT (Fecal Microbiota Transplant) donor and recipient procedures for commercial payors Report an appropriate level E/M code for the specimen collection.
Report the appropriate laboratory testing and ICD-9/10 codes for testing the donor for infectious pathogens to rule out unsuitable specimens.
Do not report 44705 if the specimen is unsuitable for transplantation.
If the specimen is suitable for transplantation then code 44705 can be reported. Unless otherwise specified by the payor, the preparation of the donor specimen is typically covered by the recipient’s insurance.
44705, Preparation of fecal microbiota for instillation, including assessment of donor specimen
The instillation of microbiota is separately reported. For instillation of microbiota by oro-nasogastric tube or enema, use 44799. For instillation via esophagogastroduodenoscopy (EGD) or colonoscopy, use the appropriate CPT code for upper gastrointestinal endoscopy or colonoscopy.
Do not report 44705 in conjunction with 74283 (Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (e.g., meconium ileus)).
NOTE: Code 44705 has a Medicare Physician Fee Schedule procedure status indicator of I (Not valid for Medicare purposes) and should not be used to report FMT for Medicare beneficiaries. See Coding and billing FMT recipient procedures for Medicare beneficiaries below.
Coding and billing FMT recipient procedures for Medicare beneficiaries
G0455, Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen.
HCPCS code G0455 includes the work of preparation AND instillation of the microbiota. Medicare does not pay a separate fee for the installation of the microbiota by oro-nasogastric tube, enema, or by upper or lower endoscopy.
Only the donor specimen that is ultimately used for the treatment of the beneficiary can be billed in conjunction with the instillation. Medicare does not cover the costs of screening of the donor specimen, thus beneficiaries should be advised of the cost of screening, which they may be at risk of paying for out-of-pocket. This may require the physician to provide an Advanced Beneficiary Notice of Non-coverage (ABN) Form to the donor and recipient beneficiary.
CPT Codes 44705
Preparation of fecal microbiota for instillation, including assessment of donor specimen
HCPCS Codes G0455
Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen
Current Policy Statement
Fecal bacteriotherapy or fecal microbiota transplant (FMT) may be considered medically necessary as a treatment for recurrent or relapsing Clostridium Difficile infection (CDI) as indicated by a positive
C. Difficile toxin stool test and defined as one of the following:
** At least 3 episodes of mild to moderate CDI and failure of a 6-8 week taper with vancomycin with or without an alternative antibiotic (e.g., rifaximin, nitazoxanide), or
** At least two episodes of severe CDI resulting in hospitalization and associated significant morbidity, or
** Moderate CDI not responding to standard therapy (vancomycin) for at least a week, or
** Severe fulminant C difficile colitis with no response to standard therapy after 48 hour
ICD-9 Codes
008.45 Intestinal infections due to clostridium difficile
ICD-10 Codes
AØ4.7 Enterocolitis due to Clostridium difficile
Cell Transplantation - CPT G0341, G0342, G0343
For services performed on or after October 1, 2004, Medicare will cover islet cell transplantation for patients with Type I diabetes who are participating in an NIH sponsored clinical trial. See Pub 100-04 (National Coverage Determinations Manual) section 260.3.1 for complete coverage policy.
The islet cell transplant may be done alone or in combination with a kidney transplant. Islet recipients will also need immunosuppressant therapy to prevent rejection of the transplanted islet cells. Routine follow-up care will be necessary for each trial patient. See Pub 100-04, section 310 for further guidance relative to routine care. All other uses for islet cell services will remain non-covered.
Healthcare Common Procedure Coding System (HCPCS) Codes
G0341: Percutaneous islet cell transplant, includes portal vein catheterization and infusion
Short Descriptor: Percutaneous islet cell trans
Type of Service: 2
G0342: Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion
Short Descriptor: Laparoscopy islet cell trans
Type of Service: 2
G0343: Laparotomy for islet cell transplant, includes portal vein catheterization and infusion
Short Descriptor: Laparotomy islet cell transp
Type of Service: 2
Applicable Modifier for Islet Cell Transplant Claims for Carriers
Carriers shall instruct physicians to bill using the above procedure code(s) with modifier QR (Item or service provided in a Medicare-specified study) for all claims for islet cell transplantation and routine follow-up care related to this service.
Special Billing and Payment Requirements for Carriers
Payment and pricing information will be on the October 2004 update of the Medicare Physician Fee Schedule Database (MPFSDB). Pay for islet cell transplants on the basis of the MPFS. Deductible and coinsurance apply for fee-for-service beneficiaries.
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