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See a sample rate comparisonCPT 38531 Fee Schedule
Last Verified: October 2026
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.
Lymph Node Surgery, Surgery On A Lymph Node. The Node May Be Removed Entirely Or A Sample Of The Tissue May Be Taken For Testing (Biopsy).
| 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 | RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $432.54 national non-facility rate (2026) · View Medicare rates for 38531 |
| Medicaid Fee Schedule | $337.69 median of the 8 states in the free preview · View Medicaid rates for 38531 |
National average reimbursement for CPT 38531 by major payers:
$612.74
$595.34
$614.86
$726.10
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CPT 38531
5 of 25 sample ratesHigher to lower in this preview
Stockton Outpatient Surgery Center LLC, Ambulatory Surgery Center Of Stockton
$4,735.00Published rateBakersfield Specialists Surgical Center, LLC
Bakersfield Specialists Surgical Center
$2,200.00Published rateHeaton Laser And Surgery Center L L C
$1,423.00Published rateJahnavi Sagi
Deaconess Hospital Inc
$763.07Published rateStephanie Preston
Deaconess Hospital Inc
$350.60Published rate
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See a sample payer proposalCPT 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 | Deep Lymph Node Surgery, Surgery On A Lymph Node Located In The Deeper Tissues Of The Body. The Node May Be Removed Entirely Along With Nearby Tissue. Alternatively A Sample Of The Tissue May Be Taken For Testing (Biopsy). |
| 38530-CPT | Moderate | Deep Lymph Node Surgery, Surgery On A Lymph Node Located In The Deeper Tissues Of The Body. The Node May Be Removed Entirely Along With Nearby Tissue. Alternatively A Sample Of The Tissue May Be Taken For Testing (Biopsy). |
| 38531-CPT | Moderate | Lymph Node Surgery, Surgery On A Lymph Node. The Node May Be Removed Entirely Or A Sample Of The Tissue May Be Taken For Testing (Biopsy). |
| 38900-CPT | Moderate | Sentinel Lymph Node Procedure, Intraoperative Identification (Eg Mapping) Of Sentinel Lymph Node(S) Includes Injection Of Non-Radioactive Dye When Performed (List Separately In Addition To Code For Primary 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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