CPT 38240 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AG - Primary physician • Q1 - Routine clinical service provided in a clinical research study |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 38240 |
National average reimbursement for CPT 38240 by major payers:
$260.56
$277.81
$340.80
$484.21
| 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 38240 | ||||||
United | 38240 | $6724.00 | 1154460525 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON LYNNWOOD ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $5354.00 | 1760486369 - MOUNTAIN EMPIRE SURGERY CENTER LP | 621772667 - (TN) MOUNTAIN EMPIRE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $1940.00 | 1952404550 - WEST PALM BEACH CHILDREN'S SURGERY CENTER, LLC | 650789191 - (FL) WEST PALM BEACH CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $6286.00 | 1215116611 - UPPER BAY SURGERY CENTER, LLC | 205547410 - (MD) UPPER BAY SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $1337.00 | 1710032842 - MSC AMBULATORY SURGICAL CENTER | 202155076 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $189.46 | 1942532437 - JESSICA HOESLI | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 38240 | $2500.00 | 1902436348 - DLV VISION ASC | 842407060 - (CA) DLV VISION ASC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $2790.00 | 1275142804 - ATLAS SURGERY CENTER, LLC, ATLAS SURGERY CENTER, LLC | 842922573 - (MN) ATLAS SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $3320.00 | 1215900246 - SUNRISE OPHTHALMOLOGY ASC LLC, FOUNDATION FOR ADVANCED EYE CARE | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $750.00 | 1932207669 - EYE SURGICAL CENTER OF MISSISSIPPI | 200669972 - (MS) EYE SURGICAL CENTER OF MISSISSIPPI | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $3229.00 | 1801869847 - AESCULAPIAN SURGERY CENTER, LLC, INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CENTER | 920179499 - (FL) AESCULAPIAN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $3765.00 | 1295897106 - WESTMONT SURGERY CENTER LLC, SALT CREEK SURGERY CENTER | 364419691 - WESTMONT SURGERY CENTER, LLC DBA SALT CREEK SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $6050.00 | 1386113090 - SURGERY CENTER OF MT. SCOTT, LLC | 832600045 | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $715.00 | 1447231287 - GASTROENTEROLOGY SPECIALISTS INC, ENDOSCOPY CENTER | 341773267 - (OH) GASTROENTEROLOGY SPECIALISTS, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38240 | $846.00 | 1063408649 - AIMS OUTPATIENT SURGERY | 860751146 - (AZ) AIMS OUTPATIENT SURGERY | AZ | 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 38240 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38240 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 38240 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) |
| 38240-CPT | Moderate | Hematopoietic Progenitor Cell (Hpc); Allogeneic Transplantation Per Donor (Revised 1/1/2013) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38240 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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