CPT 38213 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 Modifiers | • None • UB |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 38213 |
National average reimbursement for CPT 38213 by major payers:
$14.26
$16.97
$16.89
$24.61
| 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 38213 | ||||||
United | 38213 | $100.00 | 1942242441 - ADVANCED EYE SURGERY CENTER, LLC | 510567447 - (FL) ADVANCED EYE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $500.00 | 1912992900 - BOISE ENDOSCOPY CENTER, LLC, DBA MERIDIAN ENDOSCOPY CENTER | 820506078 - (ID) BOISE ENDOSCOPY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $175.00 | 1801320510 - JOHNS CREEK CENTER FOR PAIN AND SPINE | 814348805 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $351.00 | 1417217183 - PAULSEN STREET SUGERY CENTER LLC | 824075002 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $485.00 | 1306201124 - CHRISTUS SANTA ROSA OUTPATIENT SURGERY, CHRISTUS PHYSICIANS SURGERY CENTER - SAN MARCOS | 810571409 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $200.00 | 1679816342 - OAK LAWN IL ENDOSCOPY ASC LLC | 462381028 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $100.00 | 1477500767 - SOUTHPOINT SURGERY CENTER, LLC | 203579196 - (FL) SOUTHPOINT SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $395.00 | 1831686674 - CASTLE ROCK SURGICENTER, LLC | 825207935 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $1304.00 | 1710114293 - RIVERVIEW SURGERY CENTER AT THE NAVY YARD LP | 263910345 - (PA) RIVERVIEW SURGERY CENTER AT THE NAVY YARD LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $328.00 | 1083796221 - SOUTHERN INDIANA SURGERY CENTER, LLC, SOUTHERN INDIANA SURGERY CENTER | 351829838 - (IN) SOUTHERN INDIANA SURGERY CENTER | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $35.00 | 1487090452 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $505.00 | 1841222353 - DAY-OP CENTER OF LONG ISLAND LLC, DAY-OP CENTER OF LONG ISLAND | 112811353 - (NY) DAY OP CENTER OF LONG ISLAND INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $67.00 | 1205266632 - ARKANSAS RENAL GROUP PA, OUACHITA PROCEDURE CENTER | 453592104 - (AR) ARKANSAS RENAL GROUP PA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $52.00 | 1235117052 - ALLEGANY AMBULATORY SURGERY CENTER LLC | 522268598 - (MD) ALLEGANY AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38213 | $218.00 | 1063641801 - PRESBYTERIAN SAMEDAY SURGERY CENTER AT HUNTERSVILLE LLC, NOVANT HEALTH HUNTERSVILLE OUTPATIENT SURGERY | 262422926 - (NC) PRESBYTERIAN SAMEDAY SURGERY CENTER AT HUNTERSVILLE LLC | NC | 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 38213 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38213 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 38213 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 38213. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38213 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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