CPT 00938 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Anesthesia • Anesthesia for Procedures on the Perineum |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center • 21 - Inpatient Hospital |
| Common Modifiers | • None • P3 - A patient with severe systemic disease • QX - Qualified nonphysician anesthetist service: With medical direction by a physician |
| Complexity Level | Low |
National average anesthesia conversion factor for CPT 00938 by major payers:
$57.17
$55.62
$56.75
$54.24
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 00938 | ||||||
United | 00938 | $76.80 | 1346296258 - TERENCE DOORLY | 43080484 - (MA) MASS GENERAL BRIGHAM INCORPORATED | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $60.00 | 1780648535 - MARC FRIEDBERG | 43213343 - (MA) NEUROSURGICAL CONSULTANTS, INC. | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $88.25 | 1003096736 - JUSTIN MASSENGALE | 42103881 - BETH ISRAEL DEACONESS MEDICAL CENTER INC | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $76.80 | 1093003683 - HIREN PATEL | 42807148 - MASS GENERAL BRIGHAM INCORPORATED | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $88.25 | 1912988486 - KATHERINE WANG | 261149064 - (MA) NEUROLOGY REHABILITATION PC | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $86.00 | 1669765426 - PRATIK ROHATGI | 954544777 - (CA) THE REGENTS OF THE UNIVERSITY OF CALIFORNIA | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $48.00 | 1154532992 - TRACY ANSAY | 43170333 - (MA) COASTAL MEDICAL ASSOCIATES INC | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $76.80 | 1386635837 - BROOKE SWEARINGEN | 42697983 - MASS GENERAL BRIGHAM INCORPORATED | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $76.80 | 1093984742 - KURTUS DAFFORD | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $88.25 | 1386091718 - NICOLAS MARCOTTE LLC | 474353301 - (MA) NICOLAS MARCOTTE LLC | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $110.00 | 1952500191 - STEFAN KIM | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $60.00 | 1124250907 - ROBERT MILLER | 205671277 | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $62.00 | 1760617054 - GENTIAN TOSHKEZI | 522315129 | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $62.88 | 1295791150 - ARNO SUNGARIAN | 42911067 - UMASS MEMORIAL HEALTH CARE INC | MA | Neurological Surgery Physician (207T00000X) |
United | 00938 | $60.00 | 1821228883 - MINA SAFAIN | 43140938 - HALLMARK HEALTH MEDICAL ASSOCIATES INC | MA | Neurological Surgery Physician (207T00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 00938 vs. Other Anesthesia for Procedures on the Perineum Codes
The CPT 00938 code is part of the Anesthesia services used for Anesthesia for Procedures on the Perineum. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 00938 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 00862-CPT | Moderate | Anesthesia For Extraperitoneal Procedures In Lower Abdomen, Including Urinary Tract; Renal Procedures, Including Upper One-Third Of Ureter, Or Donor Nephrectomy |
| 00932-CPT | Low | Anes Male Ext Genit; Complete Amputation |
| 00936-CPT | Moderate | Anesthesia For Procedures On Male Genitalia (Including Open Urethral Procedures); Radical Amputation Of Penis With Bilateral Inguinal And Iliac Lymphadenectomy |
| 00938-CPT | Low | Anesthesia For Procedures On Male Genitalia (Including Open Urethral Procedures); Insertion Of Penile Prosthesis (Perineal Approach) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 00938. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 00938 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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