CPT® Code 0438T

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The procedure described by CPT® Code 0438T involves the transperineal placement of biodegradable material, specifically a hydrogel spacer, in the peri-prostatic area. This procedure is primarily performed to create a protective barrier between the prostate gland and the anterior rectum prior to the initiation of radiation therapy for prostate cancer. The hydrogel spacer serves a critical function by pushing the rectum away from the prostate, thereby minimizing the risk of radiation toxicity and damage to the rectal tissue during external beam radiotherapy or brachytherapy. The placement of this spacer is guided by transrectal ultrasound, which is utilized to visualize the targeted area in both longitudinal and transverse planes. This imaging technique ensures accurate identification of the perirectal fat located between Denonvilliers’ fascia and the anterior rectal wall, facilitating precise needle placement. An 18 gauge needle is then inserted through the perineum into the designated area, and a small volume of saline is injected to confirm the correct placement and to allow for hydrodissection of the space. Following this, syringes containing the biodegradable hydrogel material are connected to the needle and injected under real-time ultrasound guidance. Once the placement is confirmed to be satisfactory, the needle is withdrawn. The hydrogel material solidifies rapidly into a soft, firm substance within seconds of injection, providing effective protection for approximately three months. After this period, the hydrogel biodegrades, liquefies, and is subsequently absorbed by the body, with the remnants being excreted in the urine.