CPT 38243 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 • 58 - Staged or related procedure during postoperative period • XE - Separate encounter |
| Complexity Level | Low |
National average reimbursement for CPT 38243 by major payers:
$159.57
$171.52
$161.16
$249.58
| 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 38243 | ||||||
United | 38243 | $1449.00 | 1629130521 - MIDWEST SURGERY CENTER, LLC, MIDWEST SURGERY CENTER- WOODBURY | 411537436 - (MN) MIDWEST SURGERY CENTER | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $620.00 | 1174067318 - SKI AMBULATORY SURGICAL CENTERS, LLC | 813831008 - (AZ) SKI AMBULATORY SURGICAL CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $1327.00 | 1447768411 - WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE LLC | 821710492 - (WI) WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $357.00 | 1659343648 - SWAGEL-WOOTTON EYE CENTER, INC, EYE SURGERY CENTER OF ARIZONA | 860555229 - (AZ) SWAGEL/WOOTTON EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $1668.00 | 1386748440 - COAST CENTER FOR ORTHOPEDIC AND ARTHROSCOPIC SURGERY LLC, SHARP SAN DIEGO SURGERY CENTER | 330839637 - (CA) COAST CENTER FOR ORTHOPEDIC AND ARTHROSCOPIC SURGERY, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $910.00 | 1053688036 - SUNSET SURGICAL CENTRE LLC | 270224735 - (OR) SUNSET SURGICAL CENTRE LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $725.00 | 1700424322 - GEORGIA INTERVENTIONAL PAIN | 841727755 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $495.00 | 1164601696 - SALVATORE DIMERCURIO MD PA | 521833726 - (MD) SALVATORE DIMERCURIO, M.D., P.A. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $1250.00 | 1003116823 - NORTHERN N.J. ENDOSCOPY CENTER, L.L.C. | 640955113 - (NJ) NORTHERN NJ ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $646.73 | 1285746263 - ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC | 10731399 - (MA) ORTHOPEDIC SURGICAL CENTER OF THE NORTH SHORE | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $645.00 | 1457674236 - CORM SURGICENTER | 260681153 - (TX) CORM SURGICENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $1179.00 | 1588854772 - ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC | 201243484 - (AL) ALABAMA DIGESTIVE HEALTH | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $298.00 | 1114906393 - PHYSICIANS SURGERY CENTER LLC | 200435814 - (AR) PHYSICIANS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $1899.00 | 1164019485 - WAUKESHA SURGICENTER, LLC | 854083608 - (WI) WAUKESHA SURGICENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38243 | $1179.00 | 1841251501 - ST AUGUSTINE ENDOSCOPY CENTER LLC | 592947745 - (FL) ST AUGUSTINE ENDOSCOPY CENTER LLC | FL | 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 38243 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38243 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 38243 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 38243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38243 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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