CPT 38205 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 | • Surgery • Surgical Procedures on the Hemic and Lymphatic Systems |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • UA • AG - Primary physician |
| Complexity Level | Low |
National average reimbursement for CPT 38205 by major payers:
$108.88
$110.79
$114.06
$140.13
| 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 38205 | ||||||
United | 38205 | $200.00 | 1023103769 - OAK LAWN ENDOSCOPY LLC | 462381028 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $100.00 | 1639237092 - MUSCULOSKELETAL AMBULATORY SURGERY CENTER INC, THE SURGERY CENTER AT POINTE WEST | 650829385 - (FL) MUSCULOSKELETAL AMBULATORY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $688.00 | 1104485440 - SURGCENTER OF GREATER JACKSONVILLE, LLC | 832504492 - (FL) SURGCENTER OF GREATER JACKSONVILLE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $78.00 | 1265455463 - THE ENDOSCOPY CENTER AT BEL AIR | 470863243 - (MD) THE ENDOSCOPY CENTER AT BEL AIR | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $1446.00 | 1548238140 - DENTON SURGICARE PARTNERS LTD, BAYLOR SCOTT & WHITE SURGICARE - DENTON | 752708579 - (TX) DENTON SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $1665.00 | 1396774543 - WISCONSIN SURGERY CENTER LLC | 383661215 - (WI) WISCONSIN SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $128.00 | 1164833687 - INTERVENTIONAL PAIN MANAGEMENT LLC | 452192531 - (IN) INTERVENTIONAL PAIN MANAGEMENT LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $574.00 | 1396174454 - SURGERY CENTER OF SCOTTSDALE LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $516.00 | 1295002806 - HERITAGE ONE DAY SURGERY LLC | 453788494 - (NY) HERITAGE ONE DAY SURGERY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $95.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $92.00 | 1134300080 - METAIRIE LA ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER-METAIRIE | 205904604 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $109.00 | 1316919574 - CHEVY CHASE ASC LLC, CHEVY CHASE ENDOSCOPY CENTER | 621666144 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $737.00 | 1659316917 - SUGAR LAND SURGERY CENTER LTD | 621742196 - (TX) SUGAR LAND SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $422.26 | 1396990701 - PEACEHEALTH, ST JOSEPH MEDICAL CENTER | 910565889 - PEACEHEALTH ST JOSEPH MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38205 | $244.00 | 1962958223 - NORTHGLENN ENDOSCOPY CENTER LLC | 812984347 - (CO) NORTHGLENN ENDOSCOPY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 38205 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38205 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 38205 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 | Management Of Recipient Hematopoietic Progenitor Cell Donor Search And Cell Acquisition |
| 38205-CPT | Low | Blood-Derived Hematopoietic Progenitor Cell Harvesting For Transplantation, Per Collection; Allogenic |
| 38206-CPT | Low | Blood-Derived Hematopoietic Progenitor Cell Harvesting For Transplantation, Per Collection; Autologous |
| 38207-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Cryopreservation And Storage |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38205 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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