The new apheresis and blood and marrow transplantation-related current procedural terminology codes for payment of apheresis and blood and marrow transplantation services.
To address deficiencies in Current Procedural Terminology (CPT) codes that describe many of the clinical services offered to patients, several physicians in the blood and marrow transplantation and apheresis field joined with a coalition including the American Society of Hematology, American Society for Blood and Marrow Transplantation, American Association of Blood Banks, American Society of Clinical Oncology, American Society for Apheresis, National Marrow Donor Program, and American Red Cross to collaborate in addressing these deficiencies by designing new CPT codes. The CPT editorial panel approved 18 new or revised codes. All these codes were given permanent or temporary value by the relative value unit update committee, but not all values were approved by the Centers for Medicare & Medicaid Services (CMS), in particular, the cell-processing codes and the unrelated donor search code. Further discussions addressing these concerns are under way with the CMS. Use of these new codes allows apheresis and transplant centers to charge appropriately for these services. This will help transplant center contracts with CPT codes, with payers more specifically describing services offered to these patients. In turn, this will give better justification for payment. This may allow certain payments for services to increase and help transplant centers better allocate revenue from fixed global case rate payments. Details about the individual codes and their approval process are reviewed in this article.
Gajewski
James L
JL
Department of Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA. jlgajewski@yahoo.com
Simmons
Angela
A
Weinstein
Robert
R
Snyder
Edward
E
McMannis
John
J
Patashnik
Bernard
B
Hassenbusch
Samuel
S
LeMaistre
C Frederick
CF
Woods
Tasa
T
Denman
Corliss
C
Silver
Samuel
S
D001781:Blood Component Removal / Q000191:economics*; D016026:Bone Marrow Transplantation / Q000191:economics*; D032921:Consensus; D039702:Current Procedural Terminology; D005249:Fees and Charges; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D012051:Reimbursement Mechanisms