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 |
| Medicare Fee Schedule | View Medicare rates for 38220 |
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 | $590.00 | 1689633588 - SOUTH JERSEY ENDOSCOPY LLC, DIMARINO-KROOP-PRIETO GI ASSOC | 200478348 - (NJ) SOUTH JERSEY ENDOSCOPY LLC | NJ | 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 | $352.00 | 1417994831 - CATALINA SURGERY CENTER, LLC | 201680197 - (AZ) CATALINA SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $432.00 | 1487629044 - RALEIGH NC ENDOSCOPY ASC LLC, RALEIGH ENDOSCOPY CENTER | 200864597 - (NC) RALEIGH NC ENDOSCOPY ASC LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $442.00 | 1497949705 - IDAHO PHYSICAL MEDICINE AND REHABILITATION PA | 820435241 - (ID) IDAHO PHYSICAL MEDICINE & REHABILITATION, PA | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $506.00 | 1720268279 - PEARL ROAD SURGERY CENTER, LLC | 260812886 - (OH) PEARL ROAD SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $1418.00 | 1861743601 - FLUSHING ENDOSCOPY CENTER, LLC | 274675522 - (NY) FLUSHING ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $210.00 | 1427098201 - LAKE AREA SURGICARE LLC, SURGICARE OF LAKE CHARLES | 621658994 - (LA) LAKE AREA SURGICARE LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $893.00 | 1598996894 - SURGICAL ELITE OF AVONDALE, LLC | 270471437 - (AZ) SURGICAL ELITE OF AVONDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $685.00 | 1043271604 - NORTH FULLERTON SURGERY CENTER, LLC | 223849885 - (NJ) NORTH FULLERTON SURGERY CENTER, LLC | NJ | 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 | $3968.00 | 1578561890 - THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC | 351958962 - (IN) THE ENDOSCOPY CENTER AT ST FRANCIS LLC | IN | 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 | $548.00 | 1124125331 - AMBULATORY SURGERY ASSOCIATES, LLC, BROOKSIDE SURGERY CENTER | 383237596 - (MI) AMBULATORY SURGERY ASSOCIATES | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38220 | $2026.00 | 1306472063 - THE EMORY CLINIC INC, EMORY ENDOSCOPY CENTER AT DECATUR | 582030692 - EMORY UNIVERSITY | GA | 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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