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.