CPT 38206 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 • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 38206 by major payers:
$113.39
$110.66
$119.85
$165.98
| 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 38206 | ||||||
United | 38206 | $1179.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $856.00 | 1083653554 - UROLOGY SURGICAL PARTNERS, LLC | 582622573 - (GA) UROLOGY SURGICAL PARTNERS, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1248.00 | 1215531215 - HAUPPAUGE SC, LLC | 352651325 - (NY) HAUPPAUGE SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $850.00 | 1780157990 - RENAISSANCE SURGERY CENTER, LLC | 832673907 - (TN) RENAISSANCE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1258.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1010.00 | 1639668080 - ZAZEN SURGERY CENTER, LLC | 823788213 - (TX) ZAZEN SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $624.00 | 1659548329 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $2392.00 | 1366047433 - MANSFIELD ENDOSCOPY CENTER, LLC | 861354607 - (TX) MANSFIELD ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1955.00 | 1245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS | 831498677 - (TX) SURGCENTER OF GREATER DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $767.00 | 1962148510 - PVSCG, LLC | 842112909 - (TX) PVSCG LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $873.00 | 1508840893 - PARKWAY SURGERY CENTER | 621799370 - (SC) PARKWAY SURGERY CENTER, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $2382.00 | 1184752305 - SEASHORE SURGICAL INSTITUTE, LLC | 223660141 - (NJ) SEASHORE SURGICAL INSTITUTE | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $2480.00 | 1003127606 - MEMORIAL HERMANN ENDOSCOPY CENTER NORTH FREEWAY LLC, MEMORIAL HERMANN ENDOSCOPY CENTER NORTH LOOP | 272800702 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1065.00 | 1104468602 - PRESBYTERIAN HOSPITAL ASC, NEW MEXICO SURGERY CENTER MULTI-SPECIALTY | 842748057 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1004.00 | 1962506618 - THE POLYCLINIC, ASC POLYCLINIC SURGERY CENTER | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | 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 38206 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38206 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 38206 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 38206. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38206 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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