CPT 38241 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 • UA |
| Complexity Level | Moderate |
National average reimbursement for CPT 38241 by major payers:
$208.05
$220.72
$273.71
$358.47
| 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 38241 | ||||||
United | 38241 | $743.00 | 1669414306 - FREEDOM VISION SURGERY CENTER LLC, FREEDOM VISION SURGERY CENTER LLC | 954673469 - (CA) FREEDOM VISION SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $1328.00 | 1255386348 - SURGERY CENTER OF CHATTANOOGA LP | 113765793 - (TN) SURGERY CENTER OF CHATTANOOGA LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $588.00 | 1396193033 - NEW BERLIN MEDICAL SERVICES, LLC | 811190440 - (WI) NEW BERLIN MEDICAL SERVICES LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $308.38 | 1154769172 - JAY OBEROI | 350593390 - DEACONESS HOSPITAL INC | FL | Hospitalist Physician (208M00000X) |
United | 38241 | $733.00 | 1528032711 - COLUMBIA ENDOSCOPY CENTER, LLC | 710923725 - (MO) COLUMBIA ENDOSCOPY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $1875.00 | 1447995311 - NEW ENGLAND BAPTIST SURGERY CENTER LLC | 874311329 - (MA) NEW ENGLAND BAPTIST SURGERY CENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $952.00 | 1215931134 - CUMBERLAND VALLEY SURGICAL CENTER, LLC | 611348280 - (KY) CUMBERLAND VALLEY SURGICAL CENTER LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $622.00 | 1780656801 - CINCINNATI ASC LLC, UNIVERSITY ENDOSCOPY CENTER | 621671378 - (OH) CINCINNATI ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $695.00 | 1861491987 - THE PLASTIC SURGERY CENTER LAND, LLC | 582203578 - (GA) THE PLASTIC SURGERY CENTER LAND LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $2199.00 | 1215283866 - EC LASER AND SURGERY INSTITUTE OF WI, LLC | 454182045 - (WI) EC LASER AND SURGERY INSTITUTE OF WI LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $1196.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $1278.00 | 1558720235 - DHCH LLC | 811030907 - (NY) DHCH, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $496.00 | 1841378056 - FULL SPECTRUM EYE CARE, P.S., THE COLUMBIA RIVER EYE SURGERY CENTER | 911279261 - (WA) FULL SPECTRUM EYE CARE, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $720.00 | 1518272087 - SIPI AMBULATORY SURGERY CENTER | 300638923 - (ID) SIPI AMBULATORY SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38241 | $610.00 | 1770223901 - PSA AMBULATORY SURGICAL CENTER OF SOUTH AUSTIN, LLC | 874341110 - (TX) PSA AMBULATORY SURGICAL CENTER OF SOUTH AUSTIN LLC | TX | 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 38241 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38241 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 38241 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 |
|---|---|---|
| 38241-CPT | Moderate | Hematopoietic Progenitor Cell (Hpc); Autologous Transplantation (Revised 1/1/2013) |
| 38242-CPT | Low | Bone Marrow Or Blood-Derived Peripheral Stem Cell Transplantation: Allogeneic Donor Lymphocyte Infusions |
| 38243-CPT | Low | Hematopoietic Progenitor Cell (Hpc); Hpc Boost |
| 38300-CPT | Moderate | Drain.Lymph Node Abscessor Lymphadeniti |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38241. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38241 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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