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 |
| Medicare Fee Schedule | View Medicare rates for 38209 |
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 | $566.00 | 1427152073 - PATIENT PARTNERS LLC | 201400198 - (TN) PATIENT PARTNERS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $190.00 | 1942483433 - PREMIER PHYSICIANS CENTERS, INC | 341783789 - (OH) PREMIER PHYSICIANS CENTERS, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $64.00 | 1346581105 - MD LASER SURGERY CENTER, LLC | 462169227 - (MD) MD LASER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $1081.00 | 1649520057 - MUNSTER SPECIALTY SURGERY CENTER, LLC, MUNSTER SPECIALTY SURGERY CENTER | 454918544 - (IN) MUNSTER SPECIALTY SURGERY CENTER, LLC | IN | 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 | $3922.00 | 1003897448 - NORTHWEST SURGERY CENTER LLC, FOOT & ANKLE SURGERY CENTER | 208754071 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $570.00 | 1538245717 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $70.00 | 1598093007 - TARBORO ENDOSCOPY CENTER, LLC | 271345858 - (NC) TARBORO ENDOSCOPY CENTER LLC | NC | 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 | 38209 | $331.00 | 1750312435 - CENTRAL ARIZONA ENDOSCOPY LLC | 203643513 - (AZ) CENTRAL ARIZONA ENDOSCOPY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $122.00 | 1912480070 - SOG SURGERY CENTER LLC | 822479805 - (MS) SOG SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $322.00 | 1912053570 - BELMAR AMBULATORY SURGICAL CENTER, LLC | 200680241 - (CO) BELMAR AMBULATORY SURGICAL CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38209 | $128.00 | 1962070896 - OAK ASC, LLC | 833101804 - (IL) OAK ASC LLC | IL | 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 | $77.00 | 1568448660 - PROGRESSIVE SURGICAL INSTITUTE INC. | 232973820 - (PA) PROGRESSIVE SURGICAL INSTITUTE INC | PA | 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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