Oncology & Hematology Coding Alert

Get a handle on these sweeping changes before the New Year arrives.

Oncology practices across the country are eagerly anticipating implementing the annual CPT^® code changes, which will allow them to report new, or more accurately document, services and procedures their providers frequently perform.

Below are a few updates that may greatly impact oncology practices.

Update the Codes for These CAR T-cell Therapy Services

If your oncologist performs chimeric antigen receptor (CAR) T-cell therapy, you’re probably used to reporting those services with Category III codes (0537T-0540T) to describe harvesting, preparation and administration of the cells. Category III codes describe new and emerging technologies, but when these codes receive Food and Drug Administration (FDA) approval, CPT^® moves them to Category I status.

Beginning January 1, 2025, you should use these new Category I codes for these services:

• 38225 (Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day) replaces Category III code 0537T
• 38226 (Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (e.g., cryopreservation, storage) replaces Category III code 0538T

• 38227 (Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration) replaces Category III code 0539T
• 38228(Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous) replaces Category III code 0540T

Adjust These Autologous Skin Cell Transplant Codes

When a patient’s condition requires skin grafting, providers may elect to use an autologous skin graft to repair the defect. Point of care (POC) devices allow the provider to harvest and prepare the skin cell suspension while providing the donor skin-sparing benefits and comparable healing outcomes to standard-of-care treatments. To more accurately report this service, CPT^® has added the following codes for 2025:

• 15011 (Harvest of skin for skin cell suspension autograft; first 25 sq cm or less)
• +15012 (...each additional 25 sq cm or part thereof)
• 15013 (Preparation of skin cell suspension autograft, requiring enzymatic processing manual mechanical disaggregation of skin cells, and filtration; first 25 sq cm or less)
• +15014 (...each additional 25 sq cm of harvested skin or part thereof)
• 15015 (Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; first 480 sq cm or less)
• +15016 (...each additional 480 sq cm or part thereof)
• 15017 (Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 480 sq cm or less)
• +15018 (...each additional 480 sq cm or part thereof)

Note: You must always report codes with the “+” symbol with the appropriate parent code. If the oncologist reports the add-on code without the parent code, the claim will be denied, which delays reimbursement.

Replace These Intra-Abdominal Tumor Excision Codes  

When oncologic surgeons excise or destroy intra-abdominal cysts or tumors, you have always used codes in the 49203-49205 range. Historically, the size of the single largest cyst, endometrioma, or tumor the surgeon addressed determined your code selection. But the code definitions did not consider multiple tumors addressed in the same operative session.

CPT^® 2025 addresses this, and beginning Jan. 1, 2025, you will base your code selection on the sum of the maximum lengths of all cysts or tumors addressed during the same operative session. The total length will lead you to the proper code assignment.

So, CPT^® has deleted the 49203-49205 codes and replaced them with the following:

• 49186 (Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less)
• 49187 (... 5.1 to 10 cm)
• 49188 (... 10.1 to 20 cm)
• 49189 (... 20.1 to 30 cm)
• 49190 (... greater than 30 cm)

Note These New Prostate and Thyroid Nodule Ablation Codes

CPT^® has also introduced several new codes to describe ablation of the prostate as well as the thyroid gland. Oncologists will be able to more accurately report MRI-monitored transurethral ultrasound ablation (TULSA) technique(s) used to treat prostate cancer. The procedures, which can be performed in the outpatient setting, are minimally invasive, using ultrasound and MRI (magnetic resonance imaging) technologies to target and destroy abnormal tissues. This poses minimal risk of infection and lowered side effects.

CPT^® has added three new codes for prostate ablations for 2025:

• 51721 (Insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed)
• 55881 (Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation)
• 55882 (Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed)

Your documentation for these procedures should indicate which part of the procedure was performed. For instance, if an individual physician performed the entire procedure, the correct code assignment would be 55882. However, if a urologist and radiologist split the procedure, each would report only the code that corresponds to the service they provided: the urologist would bill 51721 and the radiologist 55881.

Lastly, CPT^® has added two new codes for thyroid ablations using radiofrequency for 2025:

• 60660 (Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency)
• +60661 (...additional lobe, percutaneous, including image guidance, radiofrequency)

As always, you should review the 2025 CPT^® code release in its entirety to ensure you have identified all updates that could impact your oncology practice.

Tiffany Steverson, CPC, CEMC, CPMA, CHONC, Pinnacle Enterprise Risk Consulting Services LLC