CPT 38550 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 • RT - Right side of body • 80 - Assistant surgeon |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 38550 |
National average reimbursement for CPT 38550 by major payers:
$693.74
$664.87
$679.31
$846.45
| 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 38550 | ||||||
United | 38550 | $935.00 | 1275821746 - OREGON EAR NOSE AND THROAT SURGERY | 452437880 - (OR) OREGON EAR NOSE AND THROAT SURGERY | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $2388.00 | 1306421268 - COLORADO UROLOGIC SURGERY CENTER, LLC, COLORADO UROLOGIC SURGERY CENTER | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $3086.00 | 1689905515 - FREMONT AMBULATORY SURGERY CENTER, L.P. | 943235450 - (CA) FREMONT AMBULATORY SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $1575.00 | 1528553559 - SURGICAL PAIN CENTER OF THE ADIRONDACKS, LLC | 821943675 - (NY) SURGICAL PAIN CENTER OF THE ADIRONDACKS LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $1500.00 | 1659463669 - ARUSHA LLC, THE SURGERY CENTER OF CHESTER COUNTY | 233076222 - (PA) ARUSHA LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $4539.00 | 1801859970 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $1300.00 | 1467544684 - TOWNE CENTRE SURGERY CENTER, LLC, ST. MARY'S OF MICHIGAN | 204943843 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $995.00 | 1144482753 - CLARKSVILLE EYE SURGERY CENTER | 261815638 - (TN) CLARKSVILLE EYE SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $1285.00 | 1972941714 - LEGENT OUTPATIENT SURGERY EULESS, LLC, LEGENT INTERVENTIONAL PAIN CENTER | 900866617 - (TX) LEGENT OUTPATIENT SURGERY EULESS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $684.00 | 1619920501 - CENTER FOR DIGESTIVE HEALTH | 364532301 - (IL) THE CENTER FOR DIGESTIVE HEALTH, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $3500.00 | 1154844553 - LONE STAR ENDOSCOPY CENTER, LLC, LONE STAR ENDOSCOPY SOUTHLAKE | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $1474.00 | 1467783233 - SOUTH SOUND SURGERY, PLLC, AUBURN SURGICAL CENTER | 204413058 - (WA) SOUTH SOUND SURGERY PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $3376.00 | 1467511899 - MERCY TERRACE HILL SURGERY CENTER, LLC, MERCY RIVER HILLS SURGERY CENTER | 421473103 - (IA) MERCY TERRACE HILL SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $1342.00 | 1154412120 - SURGICORE, INC. | 363567890 - (IL) SURGICORE INC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38550 | $2538.00 | 1427166990 - LOS ALTOS SURGERY CENTER LLC | 200864086 - (CA) LOS ALTOS | 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 38550 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38550 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 38550 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 38550. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38550 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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