CPT® Code 38226

Official Description

Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage)

Common Language Description

Chimeric antigen receptor T-cell (CAR-T) therapy represents a groundbreaking approach in the field of immunotherapy, utilizing the patient's own immune cells, specifically T-lymphocytes, to combat cancer. This innovative treatment involves a complex process where T-cells are extracted from the patient's blood and subsequently modified in a laboratory setting. The modification is achieved through the introduction of a disarmed virus that carries genetic material, enabling the T-cells to express chimeric antigen receptors (CARs) on their surface. These CARs are crucial as they empower the T-cells to identify and bind to specific protein antigens present on the surface of cancer cells, thereby facilitating targeted destruction of these malignant cells. The procedure begins with the withdrawal of blood from the patient, which may occur over several days, allowing for the separation of T-lymphocytes. Once isolated, these T-cells undergo genetic engineering to produce CARs, and they are then expanded to generate a substantial quantity, often numbering in the hundreds of millions. During this manufacturing phase, the patient typically receives lymphocytic cell-depleting chemotherapy to prepare their immune system for the subsequent infusion of the modified T-cells. After the CAR-T cells are fully prepared, they are reintroduced into the patient's body, where they seek out and eliminate cancer cells. The CAR-T cells are designed to remain active within the body for an extended period, providing ongoing surveillance against potential cancer recurrence. The specific CPT® code 38226 pertains to the preparation of these blood-derived T lymphocytes for transportation, which includes processes such as cryopreservation and storage following their initial harvesting.

1. Indications

The indications for the preparation of blood-derived T lymphocytes for transportation using CPT® code 38226 include the following:

Preparation for CAR-T Therapy This procedure is indicated for patients undergoing chimeric antigen receptor T-cell (CAR-T) therapy, where the patient's own T-lymphocytes are harvested and modified to target cancer cells.
Cancer Treatment It is specifically utilized in the treatment of certain types of cancers, where the patient's immune response needs to be enhanced to effectively combat malignant cells.

2. Procedure

The procedure for the preparation of blood-derived T lymphocytes for transportation involves several critical steps, as outlined below:

Step 1: Blood Withdrawal Blood is withdrawn from the patient, which may take place over one or more days. This step is essential for obtaining the T-lymphocytes needed for the subsequent processes.
Step 2: Separation of T-Lymphocytes After blood collection, the T-lymphocytes are separated from the other components of the blood. This separation is typically performed using apheresis, a process that isolates specific blood cells.
Step 3: Genetic Modification The isolated T-lymphocytes are then subjected to genetic modification in a laboratory or manufacturing facility. This involves introducing a disarmed virus that carries genetic material, which enables the T-cells to produce chimeric antigen receptors (CARs) on their surface.
Step 4: Expansion of Modified T-Cells Once the T-cells are genetically modified, they are expanded and multiplied to reach a sufficient quantity, often totaling hundreds of millions of CAR-T cells. This expansion is crucial for ensuring an adequate therapeutic dose for the patient.
Step 5: Cryopreservation and Storage Following the expansion, the CAR-T cells are prepared for transportation, which includes processes such as cryopreservation and storage. This step ensures that the modified T-cells remain viable until they are ready for administration back into the patient.

3. Post-Procedure

Post-procedure care following the preparation of blood-derived T lymphocytes for transportation involves monitoring the storage conditions of the cryopreserved CAR-T cells to ensure their viability. Once the cells are ready for administration, the healthcare team will prepare for the infusion process, which is typically performed in a controlled clinical setting. Patients may also receive additional supportive care and monitoring to manage any potential side effects from the lymphocytic cell-depleting chemotherapy administered prior to the CAR-T cell infusion. It is essential to ensure that the patient is adequately prepared for the subsequent steps of the CAR-T therapy, including the actual administration of the engineered T-cells back into their system.

Short Descr	CAR-T PREP T LYMPHCYT F/TRNS
Medium Descr	CAR-T THERAPY PREPJ BLD-DRV T LYMPHCYT F/TRNS
Long Descr	Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage)
Status Code	Bundled Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.