CPT 38381 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 51 - Multiple procedures • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
National average reimbursement for CPT 38381 by major payers:
$1,003.10
$1,081.05
$1,114.15
$1,325.95
| 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 38381 | ||||||
United | 38381 | $1023.00 | 1770869927 - SYRACUSE SURGERY CENTER, LLC | 453629322 - (NY) SYRACUSE SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $200.00 | 1417118241 - DIGESTIVE HEALTH COMPLEX,INC | 262808532 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $986.00 | 1679696157 - ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES, LLC, SLOCUM AMBULATORY SURGERY CENTER | 770590285 - (OR) ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $400.00 | 1538242649 - SOUTHWESTERN ENDOSCOPY CENTER, LLC | 571139709 - (PA) SOUTHWESTERN ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $336.00 | 1518155811 - THE ALTAMONTE SPRINGS FL ENDOSCOPY ASC LLC, PALM ENDOSCOPY CENTER | 260289067 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $936.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $633.00 | 1396123865 - SOUND SURGEONS PLLC, NORTHWEST WEIGHT LOSS SURGERY | 461190829 - (WA) SOUND SURGEONS, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $649.00 | 1104897644 - FOX VALLEY ORTHOPAEDIC ASSOCIATES, S.C., FOX VALLEY ORTHOPAEDIC AMBULATORY SURGICAL CENTER | 362796281 - FOX VALLEY ORTHOPAEDIC ASSOCIATES, S.C. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $2785.00 | 1225091739 - OUTPATIENT WOMEN'S AND CHILDREN'S SURGERY CENTER, LTD | 432016059 - (TX) OUTPATIENT WOMENS AND CHILDRENS SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $2575.00 | 1952364499 - DENTON REGIONAL AMBULATORY SURGERY CENTER, L.P., MEDICAL CITY SURGERY CENTER/DENTON | 200270605 - (TX) DENTON REGIONAL AMBULATORY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $2329.00 | 1477089126 - BISMARCK SINUS CENTER | 821303553 - (ND) BISMARCK SINUS CENTER | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $1064.00 | 1174777817 - INDIANA SPECIALTY SURGERY CENTER, LLC, INDIANA SPECIALTY SURGERY CENTER | 364775143 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $384.00 | 1164877684 - SMART PAIN SURGERY CENTER AT WHITE MARSH, CLEARWAY SURGERY CENTER OF WHITE MARSH | 812195231 - (MD) SMART PAIN SURGERY CENTER AT WHITE MARSH | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $565.00 | 1639142706 - AMBULATORY SURGERY CENTER LLC, AMBULATORY SURGERY CENTER | 311545306 - (KY) AMBULATORY SURGERY CENTER LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38381 | $689.00 | 1477619005 - SOUTHWEST IDAHO SURGERY CENTER, INC. | 841394136 - (ID) SOUTHWEST IDAHO SURGERY CENTER INC | ID | 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 38381 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38381 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 38381 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 38381. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38381 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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