Billing code 38243: Cell boostMedicare rate & RVUs in Virginia
Reports infusion of hematopoietic progenitor cells as a boost after failed engraftment, hematologic relapse, or graft rejection following an earlier transplant.
CMS doesn’t publish an office rate for 38243 in Virginia.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 38243 covers
A hematopoietic progenitor cell boost delivers additional blood-forming cells after an earlier transplant when engraftment has failed, the disease has relapsed hematologically, or the graft has been rejected. The transplant physician or hematologist typically performs the infusion in a hospital setting. This service is distinct from the original allogeneic or autologous transplant and from an infusion of donor lymphocytes, which is not a hematopoietic cell boost.
Report 38243 for the boost itself, supported by documentation of the prior transplant, the clinical indication, and the infused hematopoietic cell product. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment does not apply. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 38243 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $110.69 |
| Virginia | Unavailable | $99.70 |
How the 38243 rate is calculated
Each of 38243’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 38243
RVUs × geographic indexes × conversion factor
Work2.08
2.08 RVUs× 1.000 GPCI
Practice expense0.82
0.82 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
3.0400
Conversion factor
$33.4009
Medicare rate
$101.54
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38243
The CMS indicators that decide how 38243 is paid alongside other services.
CMS payment indicators · 38243
Cell boost
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
38243 without 51 · national facility
$101.54
Cell boost
38243-51 · Second procedure: 50%
$50.77
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
38243 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38240Transplt allo hct/donor
- 38240 reports allogeneic hematopoietic cell transplantation. Choose 38243 for a subsequent hematopoietic cell boost after a prior transplant.
- 38241Transplt autol hct/donor
- 38241 reports autologous hematopoietic cell transplantation. It is not the code for a later boost following an earlier transplant.
- 38242Lymphocyte infusion
- 38242 reports infusion of donor lymphocytes. Use 38243 when the infused product is a hematopoietic progenitor cell boost.
38243 billing questions
When should 38243 be chosen instead of 38240 or 38241?
Use 38243 for an additional hematopoietic cell infusion after a prior transplant in the setting of failed engraftment, hematologic relapse, or graft rejection. Codes 38240 and 38241 describe allogeneic and autologous transplantation, respectively.
How is 38243 different from donor lymphocyte infusion?
38243 is for a hematopoietic progenitor cell boost. An infusion of donor lymphocytes is a different service reported with 38242.
Does 38243 include cell collection or processing?
The service is the boost infusion, not the harvest or laboratory manipulation of cells. Review separately performed collection or processing against the applicable code instructions and documentation.
What documentation supports reporting 38243?
Document the previous transplant, the reason for the boost, and the hematopoietic cell product infused. The record should distinguish the boost from an initial transplant or donor lymphocyte infusion.
Can an assistant or another surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
How does the multiple-procedure reduction affect 38243?
When it is performed in the same session with other procedures, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. The 0-day global period includes same-day preoperative and postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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