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 |
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 | $630.00 | 1730249327 - AMBULATORY SURGERY CENTER OF WNY | 161554732 - (NY) AMBULATORY SURGERY CENTER OF WNY | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1919.00 | 1487604500 - CYPRESSWOOD SURGERY CENTER LLC, LEGENT SURGERY CENTER CYPRESSWOOD | 680600120 - (TX) CYPRESSWOOD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $475.00 | 1194999359 - JEFFREY L BOBER DPM PA, JEFFREY L BOBER DPM PA ASC | 521706931 - (MD) JEFFREY L BOBER DPM PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1200.00 | 1710425913 - FLOWOOD VASCULAR ACCESS ASC LLC | 814838440 - (MS) FLOWOOD VASCULAR ACCESS ASC LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1373.00 | 1457552846 - CHESTERFIELD SPINE CENTER, LLC, ST. LOUIS SPINE AND ORTHOPEDIC SURGERY CENTER | 205044859 - (MO) CHESTERFIELD SPINE CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1050.00 | 1902958226 - AMBULATORY SURGERY CENTER OF TUCSON, INC. | 262420656 - (AZ) AMBULATORY SURGERY CENTER OF TUCSON INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $934.00 | 1477562148 - SANI EYE CENTER, INC., SANI EYE SURGERY CENTER | 953764955 - (CA) SANI EYE CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2353.00 | 1184680225 - CAPITAL CITY SURGICAL CENTER LLC, CAPITAL CITY SURGICAL CENTER LLC | 471211202 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1199.00 | 1457683914 - ATHENS EYE SURGERY CENTER,LLC | 271467225 - (GA) ATHENS EYE SURGERY CENTERLLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $2007.00 | 1669075495 - SAINT JOSEPH HEALTH ASC LLC | 852155230 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1001.00 | 1376507194 - COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD | 752528760 - (FL) COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD | FL | 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 | $2040.00 | 1285980151 - PHYSICIANS SURGERY CENTER AT GOOD SAMARITAN, LLC, GOOD SAMARITAN SURGERY CENTER | 270573717 - (IL) PHYSICIANS SURGERY CENTER AT GOOD SAMARITAN LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38305 | $1834.00 | 1508169921 - SAINT LUKES-GI DIAGNOSTICS LLC | 274142549 - (MO) SAINT LUKESGI DIAGNOSTICS LLC | MO | 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 | 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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