CPT 38242 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 • AG - Primary physician • UA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 38242 |
National average reimbursement for CPT 38242 by major payers:
$147.30
$162.67
$170.56
$254.32
| 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 38242 | ||||||
United | 38242 | $875.00 | 1508862996 - PLASTIC SURGERY CENTER OF ST JOSEPH, INC | 200511264 - (MO) PLASTIC SURGERY CENTER OF ST JOSEPH INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $412.00 | 1578679726 - SURGEYECARE, INC., SURGEYECARE GENERAL PARTNERSHIP | 752184300 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $639.00 | 1932782315 - WAKE SPINE AND SPECIALTY SURGERY CENTER LLC, RALEIGH NEUROSURGICAL AND SPINE SURGERY CENTER | 842694789 - (NC) WAKE SPINE & SPECIALTY SURGERY | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $2782.00 | 1386609964 - SOUTH AUSTIN SURGERY CENTER LTD | 621775267 - (TX) SOUTH AUSTIN SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $1299.00 | 1417287137 - EAST PORTLAND SURGERY CENTER LLC | 271402985 - (OR) EAST PORTLAND SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $1196.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $995.00 | 1538608138 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $2392.00 | 1396700407 - ARLINGTON SURGERY CENTER, LLC, ARLINGTON SURGERY CENTER ASSOCIATES, LP | 752055800 - (TX) ARLINGTON SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $455.00 | 1255342366 - MILLMAN-DERR CENTER FOR EYE CARE, P.C., MD SURGICENTER | 382184165 - (MI) MILLMAN-DERR CENTER FOR EYE CARE, P.C. | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $761.00 | 1629647268 - UNITED VASCULAR OF HUNTSVILLE, LLC | 832575902 - (AL) UNITED VASCULAR OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $1123.00 | 1063099190 - ASCENSION SAINT THOMAS LEBANON SURGERY CENTER LLC, LEBANON SURGERY CENTER | 862679471 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $1931.00 | 1184749673 - WAYNE SURGICAL CENTER LLC | 223535325 - (NJ) WAYNE SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $687.00 | 1508845942 - ENDOSCOPY CENTER OF KNOXVILLE LP, THE ENDOSCOPY CENTER WEST | 621512837 - (TN) ENDOSCOPY CENTER OF KNOXVILLE LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $1179.00 | 1043605934 - SEASIDE SURGERY CENTER, LLC | 472399984 - (FL) SEASIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38242 | $1322.00 | 1740874031 - DOCTORS OUTPATIENT CENTER FOR SURGERY, LLC | 364928433 - (CA) DOCTORS OUTPATIENT CENTER FOR SURGERY LLC | CA | 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 38242 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38242 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 38242 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 |
| 38500-CPT | Moderate | Bx/Excis Lymph Node(S);Superfic'l-Separa |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38242 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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