CPT 38220 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 38220 by major payers:
$191.76
$218.48
$226.39
$270.38
| 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 38220 | ||||||
United | 38220 | $336.00 | 1164697009 - BOX HILL SURGERY CENTER LLC | 262454678 - (MD) BOX HILL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $275.00 | 1558844183 - MIDDLEBURG SURGERY CENTER LLC | 831229418 - (FL) MIDDLEBURG SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $290.00 | 1235165531 - LAKE SURGERY & ENDOSCOPY CENTER LTD | 593325730 - (FL) LAKE SURGERY ENDOSCOPY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $440.00 | 1619036381 - WILMINGTON AMBULATORY SURGICAL CENTER, LLC, AMERICAN SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $1298.00 | 1881789964 - NEW LEXINGTON CLINIC, PSC, LEXINGTON CLINIC AMBULATORY SURGERY CENTER | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $1379.00 | 1194770974 - HAMILTON ENDOSCOPY AND SURGERY CENTER, LLC | 223837967 - (NJ) HAMILTON ENDOSCOPY & SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $770.00 | 1366422370 - URLOGY AMBULATORY SURGERY CENTER LLC, WOLF RIVER SURGERY CENTER | 621828958 - (TN) URLOGY AMBULATORY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $747.00 | 1205845740 - THE UROLOGY CENTER LLC | 311579733 - (OH) THE UROLOGY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $800.00 | 1881151108 - ALLIANCE SURGERY CENTER AT JOHNS CREEK LLC | 833191352 - (GA) ALLIANCE SURGERY CENTER AT JOHNS CREEK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $509.00 | 1669414306 - FREEDOM VISION SURGERY CENTER LLC, FREEDOM VISION SURGERY CENTER LLC | 954673469 - (CA) FREEDOM VISION SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $396.00 | 1003889379 - THE WALDORF ENDOSCOPY ASC, LLC, WALDORF ENDOSCOPY CENTER | 621806186 - (MD) THE WALDORF ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $382.00 | 1376729715 - ENDOSCOPY ASSOCIATES OF VALLEY FORGE, LLC | 161770779 - (PA) ENDOSCOPY ASSOCIATES OF VALLEY FORGE LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $251.00 | 1578505079 - TRUXTUN SURGERY CENTER INC | 770414100 - (CA) TRUXTUN SURGERY CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $415.00 | 1356359632 - ENDOSCOPY CENTER OF NORTH MISSISSIPPI,LLC | 640915368 - (MS) ENDOSCOPY CENTER OF NORTH MISSISSIPPILLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $587.00 | 1992702443 - THE EASTSIDE ENDOSCOPY CENTER LLC | 911665997 - (WA) THE EASTSIDE ENDOSCOPY CENTER LLC | WA | 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 38220 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38220 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 38220 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 |
|---|---|---|
| 38220-CPT | Low | Diagnostic Bone Marrow; Aspiration(S) (Desc Revised 1/1/2018) |
| 38221-CPT | Low | Diagnostic Bone Marrow; Biopsy, Needle Or Trocar(Ies) |
| 38222-CPT | Moderate | Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) |
| 38230-CPT | Moderate | Bone Marrow Harvesting For Transplantation; Allogeneic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38220. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38220 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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