CPT 38209 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • UA |
| Complexity Level | Low |
National average reimbursement for CPT 38209 by major payers:
$14.78
$16.94
$34.39
$24.15
| 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 38209 | ||||||
United | 38209 | $3922.00 | 1003897448 - NORTHWEST SURGERY CENTER LLC, FOOT & ANKLE SURGERY CENTER | 208754071 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $79.00 | 1740876671 - FRESENIUS VASCULAR CARE DAYTON ASC LLC | 852997056 - (OH) FRESENIUS VASCULAR CARE DAYTON ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $2830.00 | 1881662856 - SILICON VALLEY SURGERY CENTER, LP | 770495522 - (CA) SILICON VALLEY SURGERY CENTER, L.P. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $563.00 | 1235551052 - LONG ISLAND DIGESTIVE ENDOSCOPY CENTER, LLC | 454714972 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $561.00 | 1538167978 - VALLEY SURGICAL CENTER LTD, VALLEY SURGERY CENTER | 300035229 - (OH) VALLEY SURGICAL CENTER LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $84.00 | 1689860124 - PINE GROVE AMBULATORY SURGICAL | 203237578 - (PA) PINE GROVE AMBULATORY SURGICAL | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $94.00 | 1053412189 - MILAN S CHAKRABARTY MD | 330537914 - (CA) MILAN S CHAKRABARTY MD | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $250.00 | 1790862183 - CATARACT AND LASER CENTER OF THE NORTH SHORE, LLC | 43388939 - (MA) CATARACT AND LASER CENTER OF THE NORTH SHORE LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $102.00 | 1407932619 - PACIFIC EYE INSTITUTE A MEDICAL GROUP INC, PACIFIC EYE INSTITUTE AMBULATORY SURGERY CTR | 330303507 - (CA) PACIFIC EYE INSTITUTE MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $109.00 | 1528622321 - PREMIER-COVENANT ASTC LLC, PREMIER AMBULATORY SURGERY CENTER | 834550993 - (TN) PREMIERCOVENANT ASTC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $1051.00 | 1003807835 - LAKEVIEW SURGERY CENTER LC | 421516120 - (IA) LAKEVIEW SURGERY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $102.00 | 1104857523 - SURGERY CENTER OF ST. JOSEPH, LLC | 371439847 - (MO) SURGERY CENTER OF ST JOSEPH LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $1081.00 | 1871838003 - NORTHWEST REGIONAL SURGERY CENTER, LLC | 460823847 - (IN) NORTHWEST REGIONAL SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $112.00 | 1639282932 - ATLANTA ENDOSCOPY CENTER | 582007241 - (GA) ATLANTA ENDOSCOPY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $500.00 | 1679108914 - PRECISION SC, LLC, PRECISIONCARE SURGERY CENTER | 832882696 - (NY) PRECISION SC LLC | NY | 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 38209 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38209 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 38209 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 |
| 38208-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Thawing Of Previously Frozen Harvest Without Washing (Rvsd 1/1/04) |
| 38209-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Thawing Of Previously Frozen Harvest With Washing (Rvsd 1/1/04) |
| 38210-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Specific Cell Depletion Within Harvest, T-Cell Depletion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38209. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38209 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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