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See a sample rate comparisonHealthcare 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 | LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $469.62 national non-facility rate (2026) · View Medicare rates for 38542 |
| Medicaid Fee Schedule | $371.97 median of the 8 states in the free preview · View Medicaid rates for 38542 |
National average reimbursement for CPT 38542 by major payers:

$654.30

$666.35

$708.58

$836.89
Choose a payer to see a sample of rates for CPT 38542.
Osu Wexner Medical Center Ambulatory Surgery Center, Osu Wexner Medical Center Ambulatory Surgery Center Dublin
Osu Wexner Medical Center Ambulatory Surgery Center
Surgcenter Of Palm Beach Gardens, Surgcenter Of Palm Beach Gardens, LLC
Surgcenter Of Palm Beach Gardens, LLC
Surgery Center Of Gilbert LLC, Surgery Center Of Gilbert
Surgery Center Of Gilbert, LLC
Endoscopy Center Of North Mississippi,LLC
Endoscopy Center Of North Mississippillc
Choices Women'S Medical Center, Inc.
Choices Womens Medical Center In
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Rate Benchmarking
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See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 38542 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38542 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 38542 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 |
|---|---|---|
| 38500-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). |
| 38505-CPT | Low | 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). |
| 38542-CPT | Moderate | Dissection; Deep Jugular Node(S) |
| 38792-CPT | Low | Inject Proc; Radioactive Tracer For Id Of Sentinel, Injection Procedure; Radioactive Tracer For Identification Of Sentinel |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38542 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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