38240
No office rateTransplt allo hct/donor
38240 reports allogeneic hematopoietic cell transplantation. Choose 38243 for a subsequent hematopoietic cell boost after a prior transplant.
On this page
CMS RVU26D · Effective 2026-10-01
38243 Cell boost Medicare reimbursement rates in Wyoming
Reports infusion of hematopoietic progenitor cells as a boost after failed engraftment, hematologic relapse, or graft rejection following an earlier transplant. Compare 38243 office and facility rates across CMS payment localities in Wyoming.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 38243 in Wyoming?
Wyoming has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$100.32
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Hematopoietic transplantation
About 38243: Hematopoietic cell boost
Reports infusion of hematopoietic progenitor cells as a boost after failed engraftment, hematologic relapse, or graft rejection following an earlier transplant.
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.
CMS billing rules for 38243
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.08 · 68%
- Practice expense (office) RVU0.82 · 27%
- Malpractice RVU0.14 · 5%
46
Medicare services in 2024 · #5403 by national volume
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.
38243 compared with similar codes
Office rates for Wyoming, from the same CMS release.
38241
No office rateTransplt autol hct/donor
38241 reports autologous hematopoietic cell transplantation. It is not the code for a later boost following an earlier transplant.
No office rate
38242 reports infusion of donor lymphocytes. Use 38243 when the infused product is a hematopoietic progenitor cell boost.
Compare 38243 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wyoming** →
Office / nonfacility
Unavailable
Facility
$100.32
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 38243 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
4,734
- Code
- 38243
- Physician work
- 2.08
- Practice expense
- 0.82
- Malpractice
- 0.14
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.08 | × 1.000 | 2.0800 |
| Practice expense | 0.82 | × 1.000 | 0.8200 |
| Malpractice | 0.14 | × 0.740 | 0.1036 |
| Total RVUs | 3.0036 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$100.32
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.08 | 1 |
| Practice expense | 0.82 | 1 |
| Malpractice | 0.14 | 0.74 |
(2.08 × 1 + 0.82 × 1 + 0.14 × 0.74) × $33.4009 = $100.32
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,73138240,,Transplt allo hct/donor,R,,3.90,1.89,NA,1.89,,0.25,6.04,6.04,0,XXX,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73238241,,Transplt autol hct/donor,R,,2.93,1.33,NA,1.33,,0.20,4.46,4.46,0,XXX,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73338242,,Transplt allo lymphocytes,A,,2.06,0.97,NA,0.97,,0.14,3.17,3.17,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73438243,,Transplj hematopoietic boost,A,,2.08,0.82,NA,0.82,,0.14,3.04,3.04,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73538300,,Drainage lymph node lesion,A,,2.30,8.42,,3.56,,0.61,11.33,6.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73638305,,Drainage lymph node lesion,A,,6.51,6.46,NA,6.46,,1.74,14.71,14.71,0,090,0.11,0.73,0.16,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73738308,,Incision of lymph channels,A,,6.64,5.25,NA,5.25,,1.51,13.40,13.40,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,