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 |
| Medicare Fee Schedule | View Medicare rates for 38206 |
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 | $1327.00 | 1598039125 - ROOSEVELT SURGERY CENTER, LLC | 271778024 - (NY) ROOSEVELT SURGERY CENTER, LLC | NY | 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 | $780.00 | 1801185665 - PERSEPOLIS GROUP LLC | 273653631 - (CA) PERSEPOLIS GROUP LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1193.00 | 1922141647 - RIVER NORTH SAME DAY SURGERY LLC, NORTHWESTERN MEDICINE SURGERY CENTER RIVER NORTH | 364091497 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $487.00 | 1568448660 - PROGRESSIVE SURGICAL INSTITUTE INC. | 232973820 - (PA) PROGRESSIVE SURGICAL INSTITUTE INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $9152.00 | 1528069218 - NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE, THE SURGERY SUITE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | 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 | $1210.00 | 1629703236 - NORTH CYPRESS SURGICENTER, LLC, NORTH CYPRESS SURGERY CENTER | 851383722 - (TX) NORTH CYPRESS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $956.00 | 1275821746 - OREGON EAR NOSE AND THROAT SURGERY | 452437880 - (OR) OREGON EAR NOSE AND THROAT SURGERY | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $2403.00 | 1730834730 - HERITAGE DEVELOPMENT PARTNERS, LLC, ORTHOPAEDIC SURGERY CENTER | 882720151 - (KY) HERITAGE DEVELOPMENT PARTNERS LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $573.00 | 1427690775 - CARDIAC AND VASCULAR INSTITUTE AMBULATORY SURGERY CENTER, LLC | 851809741 - (FL) CARDIAC AND VASCULAR INSTITUTE AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $1955.00 | 1508871211 - TEXAS DIGESTIVE DISEASE CENTER, LTD | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38206 | $558.00 | 1104833839 - ROCHESTER SURGERY CENTER, P.C. | 200510602 - (MI) ROCHESTER SURGERY CENTER PC | MI | 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 | $700.00 | 1730614330 - GYPSY LANE ENDOSCOPY SUITES, INC. | 475672535 - (OH) GYPSY LANE ENDOSCOPY SUITES INC | OH | 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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