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See a sample rate comparisonCPT 38243 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.
Stem Cell Boost, An Additional Infusion Of Stem Cells To Make An Original Bone Marrow Transplant More Effective.
| 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 | 58 - Staged or related procedure during postoperative period XE - Separate encounter |
| Complexity Level | Low |
| Medicare Fee Schedule | $101.54 national non-facility rate (2026) · View Medicare rates for 38243 |
| Medicaid Fee Schedule | $82.37 median of the 8 states in the free preview · View Medicaid rates for 38243 |
National average reimbursement for CPT 38243 by major payers:
$159.57
$171.52
$161.16
$215.17
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CPT 38243
5 of 25 sample ratesHigher to lower in this preview
Northshore Regional Medical Center Dba The Surgery Suite, The Surgery Suite
Ochsner Clinic Foundation
$3,825.00Published rateNorthern N.J. Endoscopy Center, L.L.C.
Northern Nj Endoscopy Center LLC
$1,250.00Published rateSurgicare Of La Veta Ltd, Laveta Surgery Center
$773.00Published rateWest Paces Surgery Center LLC
$523.00Published rateSwagel-Wootton Eye Center, Inc, Eye Surgery Center Of Arizona
Swagel/Wootton Eye Center, Ltd.
$357.00Published rate
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See a sample payer proposalCPT 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 | 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. |
| 38500-CPT | Moderate | Lymph Node Surgery, Surgery On A Lymph Node. The Node May Be Removed Entirely Or A Sample Of The Tissue May Be Taken For Testing (Biopsy). |
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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