Billing for Autologous Stem Cell Transplants

The hospital bills and shows all charges for autologous stem cell harvesting, processing, and transplant procedures based on the status of the patient (i.e., inpatient or outpatient) when the services are furnished. It shows charges for the actual transplant, in revenue center code 0362 or another appropriate cost center. ICD-9-CM or ICD-10-PCS codes are used to identify inpatient procedures.

The HCPCS codes describing autologous stem cell harvesting procedures may be billed and are separately payable under the OPPS when provided in the hospital outpatient setting of care. Autologous harvesting procedures are distinct from the acquisition services described in Pub. 100-04, chapter 4, §231.11 and section A. above for allogeneic stem cell transplants, which include services provided when stem cells are obtained from a donor and not from the patient undergoing the stem cell transplant. The HCPCS codes describing autologous stem cell processing procedures also may be billed and are separately payable under the OPPS when provided to hospital outpatients.

Payment for autologous stem cell harvesting procedures performed in the hospital inpatient setting of care, with transplant also occurring in the inpatient setting of care, is included in the MS-DRG payment for the autologous stem cell transplant.

Autologous Stem Cell Transplantation (AuSCT)

General

 Autologous stem cell transplantation (AuSCT) is a technique for restoring stem cells using the patient's own previously stored cells. AuSCT must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy (high dose chemotherapy (HDCT)) and/or radiotherapy used to treat various malignancies.

If ICD-9-CM is applicable, use the following Procedure Codes and Descriptions

41.01 Autologous bone marrow transplant without purging 

41.04 Autologous hematopoietic stem cell transplant without purging 

41.07 Autologous hematopoietic stem cell transplant with purging 

41.09 Autologous bone marrow transplant with purging

If ICD-10-PCS is applicable, use the following Procedure Codes and Descriptions -

30230AZ Transfusion of Embryonic Stem Cells into Peripheral Vein, Open Approach 

30230G0 Transfusion of Autologous Bone Marrow into Peripheral Vein, Open Approach 

30230Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Vein, Open Approach 30233G0 Transfusion of Autologous Bone Marrow into Peripheral Vein, Percutaneous Approach 30233Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Vein, Percutaneous Approach 

30240G0 Transfusion of Autologous Bone Marrow into Central Vein, Open Approach 

30240Y0 Transfusion of Autologous Bone Marrow into Central Vein, Open Approach 

30243G0 Transfusion of Autologous Bone Marrow into Central Vein, Percutaneous Approach 30243Y0 Transfusion of Autologous Hematopoietic Stem Cells into Central Vein, Percutaneous Approach 

30250G0 Transfusion of Autologous Bone Marrow into Peripheral Artery, Open Approach 

30250Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Artery, Open Approach 

30253G0 Transfusion of Autologous Bone Marrow into Peripheral Artery, Percutaneous Approach 30253Y0 Transfusion of Autologous Hematopoietic Stem Cells into Peripheral Artery, Percutaneous Approach 

30260G0 Transfusion of Autologous Bone Marrow into Central Artery, Open Approach 

30260Y0 Transfusion of Autologous Hematopoietic Stem Cells into Central Artery, Open Approach 30263G0 Transfusion of Autologous Bone Marrow into Central Artery, Percutaneous Approach

30263Y0 Transfusion of Autologous Hematopoietic Stem Cells into Central Artery, Percutaneous Approach