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See a sample rate comparisonCPT 38242 Fee Schedule
Last Verified: October 2026
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.
Bone Marrow Infusion, An Infusion Of Bone Marrow Or Stem Cells From The Original Donor Is Used After A Transplant Surgery To Help Support The Immune System In Accepting The Transplant.
| 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 | AG - Primary physician UA |
| Complexity Level | Low |
| Medicare Fee Schedule | $105.88 national non-facility rate (2026) · View Medicare rates for 38242 |
| Medicaid Fee Schedule | $85.85 median of the 8 states in the free preview · View Medicaid rates for 38242 |
National average reimbursement for CPT 38242 by major payers:
$147.30
$162.67
$170.56
$207.33
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CPT 38242
5 of 25 sample ratesHigher to lower in this preview
South Austin Surgery Center Ltd
$2,782.00Published rateHuntington Ambulatory Surgery Center, LLC
Huntington Ambulatory Surgery Center LLC
$1,418.00Published rateAscension Saint Thomas Lebanon Surgery Center LLC, Lebanon Surgery Center
$1,123.00Published rateEndoscopy Center Of Knoxville Lp, The Endoscopy Center West
Endoscopy Center Of Knoxville Lp
$687.00Published rateBrazosport Eye Facility, Inc., Brazosport Eye Institute
Brazosport Eye Facility Inc
$336.00Published rate
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See a sample payer proposalCPT 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 | Bone Marrow Or Blood-Derived P, Bone Marrow Or Blood-Derived Peripheral Stem Celltransplantation Autologous Bone Marrow Or Blood-Derived Peripheral Stem Cell |
| 38242-CPT | Low | Bone Marrow Infusion, An Infusion Of Bone Marrow Or Stem Cells From The Original Donor Is Used After A Transplant Surgery To Help Support The Immune System In Accepting The Transplant. |
| 38243-CPT | Low | Stem Cell Boost, An Additional Infusion Of Stem Cells To Make An Original Bone Marrow Transplant More Effective. |
| 38794-CPT | Moderate | Cannulation Thoracic Duct |
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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