2025 CPT code 36511
(Active) Effective Date: N/A Revision Date: N/A Surgery - Venous Catheterization, Therapeutic Apheresis and Photopheresis Procedures Surgery Feed
Therapeutic apheresis for white blood cells (leukapheresis).
Modifiers may apply depending on the circumstances of the procedure.Refer to the CPT manual and payer specific guidelines for appropriate modifier application.
Medical necessity is established when apheresis is deemed necessary to treat or manage a specific disease or condition that is not effectively managed by other treatments.Documentation should clearly demonstrate the need for the procedure based on the patient's clinical presentation and response to other therapies. Specific payer requirements for medical necessity should be reviewed.
The physician is responsible for ordering the procedure, overseeing the process, interpreting results, and managing the patient's overall care.Apheresis specialists or technicians typically perform the procedure itself under the physician's supervision. The referring physician manages the patient's underlying condition.
In simple words: This medical procedure uses a machine to clean your blood.The machine takes out certain parts of your blood, like white blood cells, and then puts the rest back in. This helps treat certain blood disorders.
Therapeutic apheresis is a procedure using specialized equipment to selectively remove blood components (plasma, leukocytes, platelets, or cells) from whole blood.The remaining blood is reinfused. Code 36511 specifically refers to the removal of white blood cells (leukapheresis). The procedure involves connecting the patient to an extracorporeal machine that separates blood components, returning the remainder to the patient.Plasmapheresis removes plasma, returning red blood cells and platelets; cytapheresis removes cellular components, returning plasma.Fluid support may be necessary depending on the type of apheresis performed.
Example 1: A patient with acute myeloid leukemia undergoing leukapheresis to reduce the white blood cell count before chemotherapy., A patient with autoimmune hemolytic anemia undergoing therapeutic apheresis to remove harmful antibodies., A patient with multiple sclerosis experiencing a relapse undergoing plasmapheresis to remove autoantibodies.
Detailed patient history, including the underlying condition requiring apheresis. Pre-procedure blood work, including complete blood count (CBC) with differential. Documentation of the type of apheresis performed (leukapheresis, plasmapheresis, etc.), the volume of blood processed, and the amount of blood components removed. Post-procedure blood work, monitoring vital signs, and assessment of the patient's response to the procedure.Physician's notes documenting medical necessity and the patient's progress.
** The information provided is based on the available data.Always refer to the most current CPT manual and payer specific guidelines for accurate coding and billing practices.Consider consulting with a medical coding specialist for complex cases.
- Revenue Code: P6C (Minor Procedures - Other)
- RVU: Information not available in provided data.Refer to CMS fee schedules for current RVU values.
- Global Days: Information not available in provided data.The global period may vary depending on the specific circumstances and payer.
- Payment Status: Active
- Modifier TC rule: Information not available in provided data.The application of a TC modifier would depend on the specific circumstances of the procedure and the payer’s guidelines.
- Fee Schedule: Information not available in provided data.Refer to historical CMS fee schedules for payment rates.
- Specialties:Hematology, Oncology, Immunology, Nephrology, Neurology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center