Extracorporeal Photopheresis (CPT code 36522)

Date Issued: 9/7/2018

According to the Centers for Medicare & Medicaid Services (CMS), extracorporeal photopheresis (CPT code 36522) is covered for the following indications:

  • Palliative treatment of skin manifestations of cutaneous T-cell lymphoma (CTCL) that has not responded to other therapy.
  • Chronic, acute on chronic, and unspecified graft-versus-host disease whose disease is refractory to standard immunosuppressive drug treatment. When a diagnosis of chronic graft-versus-host disease (ICD-10 codes D89.811–D89.813) is billed, the underlying cause (ICD-10 codes T86.01–T86.03, T86.5) must also be billed on the claim form.
  • Acute cardiac allograft rejection whose disease is refractory to standard immunosuppressive drug treatment.
  • Bone marrow transplant rejection or failure.
  • Stem cell transplant complications.
  • Bronchiolitis obliterans syndrome following lung allograft transplantation.

Indications other than those listed above billed for CPT code 36522 will be denied when billed.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part2.pdf