CPT 38525 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 38525 by major payers:
$573.83
$570.18
$610.08
$715.64
| 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 38525 | ||||||
United | 38525 | $935.00 | 1821101197 - OLYMPIA MULTI-SPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC | 911703278 - (WA) OLYMPIA MULTISPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38525 | $1512.52 | 1043298896 - ADAM ROSENBERG | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 38525 | $1228.51 | 1649421777 - ELINOR BERGER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Nurse Practitioner (363LP0200X) |
United | 38525 | $1842.53 | 1063559342 - MARGARET MACY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | 38525 | $813.50 | 1245215284 - ROBERT MUCKLE | 840861601 - (CO) DENVER EAR ASSOCIATES, LLC | CO | Specialist (174400000X) |
United | 38525 | $660.40 | 1811242605 - KIRK MITCHELL | 840744042 - (CO) COLORADO SURGICAL SERVICE P.C. | CO | Surgery Physician (208600000X) |
United | 38525 | $1300.00 | 1215957816 - SURGERY CENTER OF CENTRAL VIRGINIA INC., D.B.A. EYE SURGERY CENTER | 541816412 - (VA) SURGERY CENTER OF CENTRAL VIRGINIA INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38525 | $641.67 | 1336304310 - ASHWIN KURIAN | 841505645 - SURGONE, P.C. | CO | Surgery Physician (208600000X) |
United | 38525 | $719.59 | 1023233368 - JOHN JAMES | 10803945 - (CO) MOUNTAIN VIEW SURGICAL ASSOCIATES | CO | Surgery Physician (208600000X) |
United | 38525 | $1214.59 | 1477084937 - ANNE FLOWER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | KY | Emergency Medicine Physician (207P00000X) |
United | 38525 | $1651.00 | 1881089076 - FREEMAN SURGICAL CENTER OF PITTSBURG, LLC | 473537670 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38525 | $1842.53 | 1407863467 - DAVID MYERS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Hospitalist Physician (208M00000X) |
United | 38525 | $822.00 | 1013011162 - BAY AREA ENDOSCOPY CENTER LIMITED PARTNERSHIP | 593213374 - (FL) BAY AREA ENDOSCOPY CENTER LIMITED PARTNERSHIP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38525 | $2750.00 | 1477792828 - PRECISION SURGICENTER LLC | 262185162 - (CA) PRECISION SURGICENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38525 | $508.00 | 1316922289 - WILLIAM RODMAN | 882448941 - (CO) INFUSION FOR HEALTH P.C. | CO | Surgery Physician (208600000X) |
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 38525 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38525 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 38525 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 38525. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38525 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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