CPT 38531 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 38531 |
National average reimbursement for CPT 38531 by major payers:
$612.74
$595.34
$614.86
$746.04
| 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 38531 | ||||||
United | 38531 | $1142.00 | 1033210760 - CARLISLE ENDOSCOPY CENTER, LTD. | 251871866 - (PA) CARLISLE ENDOSCOPY CENTER LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $1427.00 | 1477586576 - BUFFALO AMBULATORY SERVICES, INC, BUFFALO AMBULATORY SURGERY CENTER | 161348390 - (NY) BUFFALO AMBULATORY SERVICES, INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $1800.00 | 1053366930 - ADVANCED SURGERY CENTER, LLC | 342045695 - (NE) ADVANCED SURGERY CENTER, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $765.00 | 1215185335 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $3050.00 | 1831576891 - ADVANCED SURGERY CENTER PERIMETER, LLC | 473080613 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $1584.00 | 1558787614 - DIGESTIVE CARE ENDOSCOPY | 464923646 - (GA) DIGESTIVE CARE ENDOSCOPY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $738.38 | 1053360107 - ADVANCED EYE SURGERY CENTER | 204771266 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $851.00 | 1699012682 - FSC INVESTMENTS, LLC, FLORISSANT SURGERY CENTER | 453808874 - (MO) FSC INVESTMENTS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $4735.00 | 1982942298 - STOCKTON OUTPATIENT SURGERY CENTER LLC, AMBULATORY SURGERY CENTER OF STOCKTON | 371709575 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $1750.00 | 1265859573 - MODESTO SPECIALTY SURGERY CENTER, PC | 454954897 - (CA) MODESTO SPECIALTY SURGERY CENTER PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $465.39 | 1013553197 - AMY MOORE | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Acute Care Nurse Practitioner (363LA2100X) |
United | 38531 | $763.07 | 1982012621 - JAHNAVI SAGI | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 38531 | $3570.00 | 1154474583 - CREEKWOOD SURGERY CENTER, LP | 431656044 - (MO) CREEKWOOD SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $3570.00 | 1194935577 - MILLENNIUM SURGICAL CENTER LLC | 205225327 - (NJ) MILLENNIUM SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38531 | $1807.00 | 1508869645 - FRESNO CA ENDOSCOPY ASC, LP, CENTRAL CALIFORNIA ENDOSCOPY CENTER | 912127626 - (CA) FRESNO CA ENDOSCOPY ASC LP | CA | 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 38531 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38531 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 38531 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 |
|---|---|---|
| 38525-CPT | Moderate | By/Excis. Lymph Node(S); Deep Axillary N |
| 38530-CPT | Moderate | Biopsy/Exc Internal Mammary Node |
| 38531-CPT | Moderate | Biopsy Or Excision Of Lymph Node(S); Open Inguinofemoral Node(S) |
| 38765-CPT | High | Inguinofemoral Lymphadenectomy, Superficial, In Continuity With Pelvic Lymphadenectomy, Including External Iliac, Hypogastric, And Obturator Nodes (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38531. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38531 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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