CPT 38305 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 • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 38305 |
National average reimbursement for CPT 38305 by major payers:
$626.90
$631.44
$635.90
$799.68
| 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 38305 | ||||||
United | 38305 | $2353.00 | 1811433410 - OPHTHALMOLOGY SURGERY CENTER OF ORLANDO LLC, ORLANDO OPHTHALMOLOGY SURGERY CENTER | 814378043 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1600.00 | 1629376207 - MARTEL EYE INSTITUTE LLC | 275350554 - (CA) MARTEL EYE INSTITUTE LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1919.00 | 1578610564 - HOLDINGS OF SPINECARE, LLC, SPINECARE LLP | 200950730 - (TX) HOLDINGS OF SPINECARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2388.00 | 1104246446 - PACIFIC ENDOSCOPY CENTER LLC | 203905706 - (HI) PACIFIC ENDOSCOPY CENTER, LLC | HI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2353.00 | 1881013142 - ADVANCED SURGERY CENTER OF TAMPA, LLC | 463891843 - (FL) ADVANCED SURGERY CENTER OF TAMPA, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1285.00 | 1316919574 - CHEVY CHASE ASC LLC, CHEVY CHASE ENDOSCOPY CENTER | 621666144 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1188.00 | 1013997915 - KNOXVILLE OPHTHALMOLOGY ASC, LLC, EYE SURGERY CENTER OF EAST TENNESSEE | 621595885 - (TN) KNOXVILLE OPHTHALMOLOGY ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2307.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2313.00 | 1093731101 - EAST BRUNSWICK SURGERY CENTER LLC, UNIVERSITY SURGICENTER | 20593133 - (NJ) EAST BRUNSWICK SURGERY CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $900.00 | 1750420147 - INTERVENTIONAL SPINE AND PAIN MANAGEMENT AMBULATORY SURGICAL CENTER, ISPM ASC | 205896580 - (GA) INTERVENTIONAL SPINE AND PAIN MANAGEMENT AMBULATORY SURGICAL CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1087.00 | 1619124401 - CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | 562059693 - (NC) CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2388.00 | 1326435926 - SELECT PHYSICIANS SURGERY CENTERS | 383935220 - (FL) SELECT PHYSICIANS SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2206.00 | 1144331760 - RESURGENS SURGERY CENTER LLC | 582397841 - (GA) RESURGENS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1460.00 | 1518149954 - NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER, LLC | 141983013 - (GA) NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1001.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | GA | 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 38305 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38305 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 38305 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38305 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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