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Liver Normothermic Pump Surgical CPT Codes

New CPT Category III codes for the surgical work and time involved in preparing and placing a liver allograft onto a normothermic perfusion device and decannulating the liver will be available beginning July 1, 2024.

The codes are listed below with their official descriptions: X261T, X262T, and X263T.

These new Category III CPT codes do NOT have any RVUs connected to them; a documented use of these codes with proper reporting to CMS is required before moving these codes to Category I and receiving formal RVUs and payment. For future RUC processes, an estimated usage of these codes will determine their RVU assignment.

Please submit these CPT codes even though there is no payment currently.

    Cat III NRP

    NPR codes

    ASTS Guide on Professional Coding

    The ASTS Business Practice Services Committee and Legislative and Regulatory Committee are happy to update the original 2012 CPT guide for transplant professionals with 2024 information.


    We hope that you find this handy guide easy to use and helpful. Please refer to your latest edition of the American Medical Association (AMA) CPT Professional Edition for additional codes, terminology, rules, and guidelines and discuss this with your professional and hospital coding specialists.  We also are supplying free online resources on the CMS website that are updated with new information every year.


    Respectfully Submitted,


    Ken Andreoni, MD, FACS


    View the coding guide as a PDF!

    Heart/Lung Transplantation

    Recipient heart with or without lung allotransplantation

    (For artificial heart systems with cardiectomy, see category III codes 0051T-0053T)

    33930 Donor cardiectomy-pneumonectomy including cold preservation

    33933 Backbench preparation of cadaver donor heart/lung prior to transplantation

    33935 Heart-lung transplant with recipient cardiectomy-pneumonectomy

    33940 Donor cardiectomy (including cold preservation)

    33944 Backbench preparation of cadaver donor heart prior to transplantation

    33945 Heart transplant, with our without recipient cardiectomy

    Intestinal Transplantation

    Allograft Preparation

    44715 Backbench preparation of cadaver or living donor intestine prior to transplantation

    44720 Backbench reconstruction of cadaver or living donor allograft, venous anastomosis, each

    44721 Backbench reconstruction of cadaver or living donor allograft, arterial anastomosis, each

    44799 Unlisted procedure, intestine


    44135 Intestinal allotransplantation, from cadaver donor

    44136 From living donor

    44137 Removal of transplanted intestinal allograft, complete

    44139 Mobilization of splenic flexure performed in conjunction with partial colectomy

    44140 Colectomy, partial with anastomosis

    44015 Needle catheter jejunostomy (surgical feeding tube)

    43500 Gastrostomy, exploration (surgical G-tube)

    Donor Enterectomy

    44132 Donor enterectomy (including preservation), open from cadaver

    44133 partial, from living donor

    Liver Transplantation

    47133 Donor hepatectomy (including preservation) from cadaver

    47135 Liver allotransplantation; orthotopic, partial or whole

    47140 Living donor hepatectomy (including preservation), left lateral segment (II, III)

    47141 total left lobectomy (segments II, III and IV)

    47142 total right lobectomy (segments V, VI, VII, VIII)

    47143 Backbench standard preparation of cadaver donor whole liver graft, including cholecystectomy; without trisegmentectomy or lobe split

    47144 with trisegment split of whole liver graft into 2 partial liver grafts (ie. left lateral segment (II, III)


    44145 with lobe split of whole liver graft into 2 partial liver grafts (ie. left lobe and right lobe segment

    47146 Backbench reconstruction of cadaver or living donor allograft, venous anastomosis, each

    47147 Backbench reconstruction of cadaver or living donor allograft, arterial anastomosis, each

    47780 Anastomosis, Roux en Y, of extrahepatic duct (fuse bile ducts to bowel)

    47785 Fuse Intrahepatic bile ducts to bowel

    47800 Duct to duct anastomosis (Choledochocholedocostomy)

    47801 Placement of choledochal stent

    47802 Fuse liver duct and intestine (choledochoduodenostomy)

    47900 Suture bile duct injury

    47001 Liver Needle Biopsy when done with other procedure

    Other Liver Procedures

    47350 Management of liver hemorrhage, simple suture


    47360 complex suture of liver wound or injury


    47361 extensive debridement, coagulation w w/o packing

    47362 re-exploration of hepatic wound for removal of packing

    48000 Drainage of abdomen

    49000 Exploration of Abdomen

    49002 Re-Opening of Abdomen

    35840 Re-Opening for hemorrhage (some coders may not allow this for abd)

    Lung Transplantation

    32850 Donor pneumonectomy(s)(including cold preservation)

    32851 Lung transplant, single; without cardiopulmonary bypass

    32852 with cardiopulmonary bypass

    32853 Lung transplant, double (bilateral sequential or en bloc)

    32854 with cardiopulmonary bypass

    32855 Backbench standard preparation of single cadaver donor lung allograft


    32856 Backbench bilateral lung preparation

    Pancreas Transplantation

    48160 Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or islet cells

    48550 Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation

    48551 Backbench standard preparation of cadaver donor allograft prior to transplantation including splenectomy, duodenotomy, CBD ligation, Y graft arterial anastomosis

    48552 Backbench reconstruction of donor pancreas, venous anastomosis, each

    48554 Transplantation of pancreas allograft

    48556 Removal of transplanted pancreatic allograft

    48999 Unlisted procedure, pancreas

    Renal Transplantation

    50300 Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral

    50320 Remove kidney open from living donor (Donor Nephrectomy)

    50323 Backbench standard preparation of cadaver donor renal allograft prior to transplantation.

    50325 Backbench standard preparation of living donor renal allograft prior to transplantation

    50327 Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis each

    50328 arterial anastomosis, each

    50329 ureteral anastomosis, each

    50340 Recipient nephrectomy (separate procedure; removal of native kidney)

    50360 Renal allotransplantation, implantation of graft; without recipient nephrectomy 

    50365 with recipient nephrectomy

    50370 Removal of transplanted renal allograft

    50380 Renal autotransplantation, reimplantation of kidney 

    50605 Insertion of indwelling stent, all types 

    50500 Repair of kidney wound

    50547 Lap removal donor kidney (Lap donor nephrectomy)

    50760 Fusion of ureters

    50780 Reimplant of ureter in bladder

    52310 Cystoscopy with simple removal of ureteral stent

    Hemodialysis Access

    36800 Insertion of cannula for hemodialysis 36810 arteriovenous, external (Scribner type)

    36815 arteriovenous, external revision, or closure

    36818 Arteriovenous anastomosis, open; upper arm cephalic vein transposition

    36819 Arteriovenous anastomosis, open; upper arm basilic vein transposition

    36820 Arteriovenous anastomosis, open; by forearm vein transposition

    36821 Arteriovenous anastomosis, open; direct, any site (eg Cimino type)

    Peritoneal Dialysis Catheter

    49422 Removal PD Catheter

    49421 Open placement PD Catheter

    49324 Laparoscopic placement PD Catheter (Omentopexy add-on 49326)

    49435 Add on for subcutaneous extension of catheter (eg to chest in obese patient)

    49436 Delayed creation of exit site for previously embedded subcutaneous PD Catheter

    Abdominal Wall Hernias: (new 2023)

    49591 Any anterior abd wall initial, reducible hernia (open or lap), includes mesh if used, less than 3 cm (same, but recurrent hernia: 49613)

    49592 – as above, incarcerated or strangulated less than 3 cm (recurrent 49614)

    49593 – as 49591 (reducible), but 3 to 10 cm total length (recurrent 49615)

    49594 – as 49592 (incarcerated / strangulated), but 3 to 10 cm total length (recur 49616)

    49595 – as 49591 (reducible), but > 10 cm total length (recurrent 49617)

    49596 - as 49592 (incarcerated / strangulated), but > 10 cm total length (recurrent 49618)

    Commonly Used Procedure Modifiers

    22* Unusual procedure. Use this for procedures that require additional work (e.g. lysis of adhesions, retransplant etc) or are very difficult. * must specify level of difficulty 25%, 50%, 75% or 100% more than usual. Op note must support level. TAllows for additional charges based on percent specified.

    58 Staged Procedure. Use this for planned take back operation. (abdominal packing for 24 hours, etc) . Allows for additional charge above primary procedure.

    62 Two Surgeons/Different Skills. Use this when two attendings perform a case together and can split the case into two parts. Requires two operative notes from each surgeon to add up to one whole case. (e.g. One surgeon dictates backbench and implant graft; other surgeon dictates native organ removal). Allows charges at 125% rather than usual 110% (100% attending, 10% assistant fee).

    80 Assistant Surgeon

    82 Assistant Surgeon when no qualified resident is available.

    80 or 82 Allows 10% assistant fee per CMS guidelines. Standard major transplant operations qualify (50360.82, 47135.82, 48544.82). Documentation of the non-availability of a qualified resident is suggested.

    See CPT book for additional codes and modifiers.

    Additional Resources:


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