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See a sample rate comparisonCPT 38100 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Splenectomy Total
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Hemic and Lymphatic Systems |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 23 - Emergency Room |
| Common Modifiers | GC - Service performed by resident under supervision 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | $1,073.84 national non-facility rate (2026) · View Medicare rates for 38100 |
| Medicaid Fee Schedule | $833.36 median of the 8 states in the free preview · View Medicaid rates for 38100 |
National average reimbursement for CPT 38100 by major payers:
$1,397.86
$1,491.98
$1,612.17
$1,811.77
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CPT 38100
5 of 25 sample ratesHigher to lower in this preview
Waukee Surgery Center LLC
$2,896.59Published rateSummit Ambulatory Surgical Center LLC
$1,064.00Published rateWestern Washington Medical Group, Inc, Ps, Dba: Gateway Surgery Center
Western Washington Medical Group, Inc., P.S.
$885.00Published rateCentric Ambulatory Surgery Center LLC
$525.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$63.00Published rate
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See a sample payer proposalCPT 38100 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38100 code is part of the Surgery services used for Surgical Procedures on the Hemic and Lymphatic Systems. 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 38100 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 |
|---|---|---|
| 38100-CPT | High | Splenectomy Total |
| 38101-CPT | High | Splenectomy; Partial |
| 38102-CPT | Moderate | Splenectomy Total En Bloc Fo, Splenectomy Total En Bloc For Extensive Diseaseinconjunction With Other Procedure (List In Addit Ion To Code For Primary Procedure) |
| 38115-CPT | High | Rpair Of Rupture Spleen (Splenorrhaphy) W//W/O Partial Sple, Repair Of Ruptured Spleen (Splenorrhaphy) With Or Without Partial Sple |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38100 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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