CMS Pub. 100-04, ch. 32, § 190.2

Codes and Procedure Code

(Rev. 12822; Issued:09-05-024; Effective:10-01-23 Implementation:11-07-24)

The following HCPCS procedure code is used for billing extracorporeal photopheresis:

• 36522 - Photopheresis, extracorporeal

Effective for claims with dates of service on or after Oct 1, 2015, the following are the applicable ICD-10-

CM procedure codes for the new expanded coverage:

• 6A650ZZ Phototherapy, Circulatory, Single

• 6A651ZZ Phototherapy, Circulatory, Multiple

NOTE: Contractors shall edit for an appropriate oncological and autoimmune disorder diagnosis for

payment of extracorporeal photopheresis according to the NCD.

Effective for claims with dates of service on or after Oct 1, 2015, in addition to HCPCS 36522, the following

ICD-10-CM codes are applicable for extracorporeal photopheresis for the treatment of BOS following lung

allograft transplantation only when extracorporeal photopheresis is provided under a clinical research study as

outlined in above sections 190 and 190.2 Healthcare Common Procedural Coding System (HCPCS) codes,

and applicable diagnosis codes as below::

A reference listing of ICD-10-CM coding and descriptions is listed below:

CUTANEOUS T-CELL LYMPHOMA

C84.01 Mycosis fungoides, lymph nodes of head, face, and neck

C84.02 Mycosis fungoides, intrathoracic lymph nodes

C84.03 Mycosis fungoides, intra-abdominal lymph nodes

C84.04 Mycosis fungoides, lymph nodes of axilla and upper limb

C84.05 Mycosis fungoides, lymph nodes of inguinal region and lower limb

C84.06 Mycosis fungoides, intrapelvic lymph nodes

C84.07 Mycosis fungoides, spleen

C84.08 Mycosis fungoides, lymph nodes of multiple sites

C84.09 Mycosis fungoides, extranodal and solid organ sites

C84.11 Sézary disease, lymph nodes of head, face, and neck

C84.12 Sézary disease, intrathoracic lymph nodes

C84.13 Sézary disease, intra-abdominal lymph nodes

C84.14 Sézary disease, lymph nodes of axilla and upper limb

C84.15 Sézary disease, lymph nodes of inguinal region and lower limb

C84.16 Sézary disease, intrapelvic lymph nodes

C84.17 Sézary disease, spleen

C84.18 Sézary disease, lymph nodes of multiple sites

C84.19 Sezary disease, extranodal/solid organ sites

C84.A0 Cutaneous T-cell lymphoma, unspecified, unspecified site

C84.A1 Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck

C84.A2 Cutaneous T-cell lymphoma, unspecified, intrathoracic lymph nodes

C84.A3 Cutaneous T-cell lymphoma, unspecified, intra-abdominal lymph nodes

C84.A4 Cutaneous T-cell lymphoma, unspecified, lymph nodes of axilla and upper limb

C84.A5 Cutaneous T-cell lymphoma, unspecified, lymph nodes of inguinal region and lower limb

C84.A6 Cutaneous T-cell lymphoma, unspecified, intrapelvic lymph nodes

C84.A7 Cutaneous T-cell lymphoma, unspecified, spleen

C84.A8 Cutaneous T-cell lymphoma, unspecified, lymph nodes of multiple sites

C84.A9 Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites

ACUTE CARDIAC ALLOGRAFT REJECTION/GRAFT-VERSUS-HOST-DISEASE

D89.811 Chronic graft-versus-host disease

D89.812 Acute on chronic graft-versus-host disease

D89.813 Graft-versus-host disease, unspecified

T86.01 Bone marrow transplant rejection

T86.02 Bone marrow transplant failure

T86.03 Bone marrow transplant infection

T86.21 Heart transplant rejection

T86.22 Heart transplant failure

T86.23 Heart transplant infection

T86.290 Cardiac allograft vasculopathy

T86.31 Heart-lung transplant rejection

T86.32 Heart-lung transplant failure

T86.33 Heart-lung transplant infection

T86.5 Complications of stem cell transplant

Z94.3 Heart and lungs transplant status

Z94.81 Bone marrow transplant status

BOS (CED/TRIAL ONLY)

J42 Unspecified chronic bronchitis

J44.0 Chronic obstructive pulmonary disease with (acute) lower respiratory infection

J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation

J44.81

J44.9

Bronchiolitis obliterans and bronchiolitis obliterans syndrome - Effective 10/1/23

Chronic obstructive pulmonary disease, unspecified

T86.810 Lung transplant rejection

T86.811 Lung transplant failure

T86.812 Lung transplant infection

T86.818 Other complications of lung transplant

T86.819 Unspecified complication of lung transplant

Z94.2 Lung transplant status

Z00.6 Encounter for examination for normal comparison and control in clinical research program