CMS To Recognize
Cell Processing Codes
Beginning in January, the Centers for Medicare and Medicaid Services (CMS) will begin recognizing the CPT codes for bone marrow/stem cell processing.
It will be important for transplant centers and laboratories to begin the new year accurately billing for these procedures, ASBMT officials say. As CMS receives claims data for the procedures, it will begin building a database of the actual costs.
The cell processing codes – 38207 through 38215 – have been part of the AMA’s Current Procedure Terminology (CPT) code since 2003, but have not been recognized for reimbursement by CMS. As of Jan. 1 there will be no need to bill Medicare and Medicaid differently than private payers.
“CMS says that in recognizing the cell processing codes, it will be better able to distinguish the costs of these procedures and set more appropriate payments,” according to Dr. James Gajewski, chair of the ASBMT Committee on CPT Codes.
The cell processing codes are:
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38207 |
Transplant preparation of hematopoietic progenitor cells; cyropreservation and storage |
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38208 |
Thawing of previously frozen harvest |
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38209 |
Washing of harvest |
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38210 |
T-cell depletion |
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38211 |
Tumor cell depletion |
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38212 |
Red blood cell removal |
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38213 |
Platelet depletion |
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38214 |
Plasma (volume) depletion |
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38215 |
Cell concentration in plasma, mononuclear, or buffy coat layer |
“Together with AABB, ASH and others we have worked hard to urge CMS to recognize these codes,” Dr. Gajewski said. “The next step after January is to help CMS establish fair reimbursement for these laboratory-specific procedures, and this can be done with complete and accurate billing.”
The proposed payment rate for cryopreservation and thawing (codes 38207-38209) will be $54.69, compared to $14.11 now. The proposed payment rate for cell depletion (codes 38210-38215) will be $222.44, compared to $212.58 now.
“The payment rates are clearly inadequate, but CMS has promised that with charges accumulating in the database over the next two years, the agency will be able to reassess and move rates to a more appropriate level," Dr. Gajewski said. "It is important that all providers of stem cell transplant and cell processing services accurately bill for these services starting Jan. 1.”
It is not yet known how to bill for off-site cell processing such as when a local blood center performs cell processing services for a hospital, he said.