CPT 38555 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • LT - Left side of body • AG - Primary physician |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 38555 |
National average reimbursement for CPT 38555 by major payers:
$1,370.06
$1,332.73
$1,340.78
$1,667.20
| 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 38555 | ||||||
United | 38555 | $1633.00 | 1689029316 - LIBERTY ENDOSCOPY, LLC | 464588779 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $797.00 | 1740398445 - HARRISON SURGERY CENTER, LLC | 201117764 - (AR) HARRISON SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $935.00 | 1588679179 - SPECIALTY SURGICAL CENTER OF ENCINO LP | 954816334 - (CA) SPECIALTY SURGICAL CENTER OF ENCINO, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $1747.00 | 1356773584 - SURGERY CENTER OF MUNSTER, LLC, THE CENTER FOR MINIMALLY INVASIVE SURGERY | 461961043 - (IN) SURGERY CENTER OF MUNSTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $950.00 | 1205978780 - MOUNTAIN HOME SURGERY CENTER | 454157268 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $1150.00 | 1093760019 - OCEAN COUNTY EYE ASSOCIATES LLC, OCEAN COUNTY EYE SURGERY CENTER | 223256927 - (NJ) OCEAN COUNTY EYE ASSOCIATES, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $3553.00 | 1902877715 - AMBULATORY SURGICAL CENTER OF MORRIS COUNTY LLC, RIDGEDALE SURGERY CENTER | 223104481 - (NJ) AMBULATORY SURGICAL CENTER OF MORRIS COUNTY, INC. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $935.00 | 1417935206 - DIGESTIVE DISEASE CENTER, LP, MEMORIAL CARE DIGESTIVE CARE CENTER SADDLEBACK MEMORIAL, AN AFFILIATE | 330292435 - (CA) DIGESTIVE DISEASE CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $1100.00 | 1942956123 - METROLINA VASCULAR ACCESS CARE LLC | 831967528 - (NC) METROLINA VASCULAR ACCESS CARE LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $1282.00 | 1962668319 - BOULDER MEDICAL CENTER, PC, BOULDER MEDICAL CENTER ASC | 840834835 - BOULDER MEDICAL CENTER, P.C. | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $2122.00 | 1669705034 - EYE SPECIALISTS SURGERY CENTERS, LLC, MUNCIE SURGICAL CARE CENTER | 270927202 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $2257.00 | 1780673327 - LAKEWOOD SURGERY CENTER, LLC | 371470145 - (NJ) LAKEWOOD SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $963.00 | 1962455964 - CYPRESS SURGERY CENTER LLC | 481214301 - (KS) CYPRESS SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $8705.00 | 1558876037 - BELTWAY SURGERY CENTERS, LLC, EAST WASHINGTON SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38555 | $760.00 | 1821459496 - GEM STATE ENDOSCOPY | 352553021 - (ID) GEM STATE ENDOSCOPY | ID | 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 38555 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38555 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 38555 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 38555. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38555 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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