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See a sample rate comparisonCPT 38204 Fee Schedule
Last Verified: October 2026
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.
Managmnt Of Recipient Hematopoie Progenitor Cell Donor Search &, Management Of Recipient Hematopoietic Progenitor Cell Donor Search And
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Hemic and Lymphatic Systems |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | AG - Primary physician UA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 38204 |
| Medicaid Fee Schedule | $77.78 median of the 8 states in the free preview · View Medicaid rates for 38204 |
National average reimbursement for CPT 38204 by major payers:
$124.28
$135.54
$141.16
$168.47
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CPT 38204
5 of 25 sample ratesHigher to lower in this preview
Pottstown Hospital Company LLC, Pottstown Memeorial Medical Center
$1,681.00Published rateGraystone Eye Surgery Center LLC
$770.00Published rateCardiovascular Asc LLC
$547.00Published rateUnited Shockwave Services, Ltd., United Therapies
$275.00Published rateAlysen Weinzapfel
Deaconess Hospital Inc
$85.80Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 38204 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38204 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 38204 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 |
|---|---|---|
| 38204-CPT | Low | Managmnt Of Recipient Hematopoie Progenitor Cell Donor Search &, Management Of Recipient Hematopoietic Progenitor Cell Donor Search And |
| 38205-CPT | Low | Stem Cell Collection, Collection Of Blood-Derived Stem Cells From A Donor. The Stem Cells Will Be Used To Regenerate Bone Marrow Or An Immune System Damaged By Chemotherapy Or Radiation. |
| 38206-CPT | Low | Stem Cell Collection, Collection Of Blood-Derived Stem Cells From A Donor. The Stem Cells Will Be Used To Regenerate Bone Marrow Or An Immune System Damaged By Chemotherapy Or Radiation. |
| 38207-CPT | Low | Transplnt Prep Of Hematopoie Progenitor Cells; Cryopreserva, Transplant Preparation Of Hematopoietic Progenitor Cells; Cryopreserva |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38204. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38204 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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