CPT 38212 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 • Q1 - Routine clinical service provided in a clinical research study |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 38212 |
National average reimbursement for CPT 38212 by major payers:
$53.50
$65.49
$74.87
$81.59
| 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 38212 | ||||||
United | 38212 | $111.00 | 1831116698 - LASER AND OUTPATIENT SURGERY CENTER LLC | 201098451 - (FL) LASER AND OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $566.00 | 1427003052 - EYE SURGERY CENTER OF NASHVILLE LLC | 621872622 - (TN) EYE SURGERY CENTER OF NASHVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $107.00 | 1255526265 - CONROE TX ENDOSCOPY ASC LLC, RIVER OAKS ENDOSCOPY CENTER | 260269714 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $76.00 | 1225050347 - STATE HILL SURGICENTER LLC | 203106650 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $400.00 | 1871033878 - REDMOND AMBULATORY SURGERY CENTER, LLC | 813558711 - (WA) REDMOND AMBULATORY SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $992.00 | 1922301712 - THE SURGERY CENTER AT WILLIAMSON LLC | 270929515 - (TX) THE SURGERY CENTER AT WILLIAMSON LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $146.00 | 1891865077 - REGENCY SURGERY CENTER, LLC | 710973677 - (CA) REGENCY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $61.00 | 1720227176 - ST. AGNES HEALTHCARE, INC., GEORGE THOMAS GRACE M.D. SURGERY CENTER | 520591657 - ST AGNES HEALTHCARE INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $200.00 | 1912447418 - LUBBOCK SURGERY CENTER, LLC | 812766547 - (TX) LUBBOCK SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $95.00 | 1609399963 - INTERVENTIONAL SURGERY INSTITUTE OF WHITE HALL LLC | 814296629 - (AR) INTERVENTIONAL SURGERY INSTITUTE OF WHITE HALL LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $66.00 | 1639215502 - BOSTON EYE SURGERY & LASER CENTER TRUST, BOSTON EYE SURGERY & LASER CENTER | 43092292 - (MA) BOSTON EYE SURGERY & LASER CENTER TRUST | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $650.00 | 1730151168 - HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP, HAWTHORN SURGERY CENTER | 582065044 - (IL) HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $344.00 | 1770076010 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC ASC SAFFORD | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $136.00 | 1679544290 - KEYSTONE SURGERY CENTER, LTD | 43712391 - (PA) KEYSTONE SURGERY CENTER LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38212 | $90.00 | 1649443367 - SKIN SURGERY CENTER OF VIRGINIA | 262319829 - (VA) SKIN SURGERY CENTER OF VIRGINIA | VA | 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 38212 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38212 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 38212 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 |
|---|---|---|
| 38211-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Tumor Cell Depletion |
| 38212-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Red Blood Cell Removal |
| 38213-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Platelet Depletion |
| 38214-CPT | Low | Transplant Preparation Of Hematopoietic Progenitor Cells; Plasma (Volume) Depletion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38212. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38212 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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