CPT 38746 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 38746 by major payers:
$290.49
$306.54
$316.80
$361.62
| 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 38746 | ||||||
United | 38746 | $1000.00 | 1447612114 - LPC SURGERY CENTER LLC | 473748606 - (IN) LPC SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $99.00 | 1396192241 - ANDERSON ENDOSCOPY CENTER LLC | 811947476 - (OH) ANDERSON ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $662.00 | 1710037452 - ILLINOIS SPORTS MEDICINE & ORTHOPEDIC SURGERY CENTER, LLC | 201054630 - (IL) ILLINOIS SPORTS MEDICINE AND ORTHOPEDIC SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $1064.00 | 1568674281 - VILLAGES ENDOSCOPY & SURGICAL CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $115.00 | 1164513149 - ENDO-SURGI OF UNION ASC LLC | 223248249 - (NJ) ENDO-SURGI CENTER, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $105.00 | 1811228083 - MESQUITE SURGERY CENTER LLC | 270170010 - (AZ) MESQUITE SURGERY CENTER, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $6068.00 | 1720603079 - TEXAS HEALTH SURGERY CENTER CHISHOLM TRAIL, LLC | 851225852 - (TX) TEXAS HEALTH SURGERY CENTER CHISHOLM TRAIL LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $430.00 | 1265542849 - GREAT LAKES EYE SURGERY CENTER LLC | 205428461 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $782.00 | 1568420388 - GREAT LAKES SURGICAL CENTER LLC | 562350398 - (MI) GREAT LAKES SURGICAL CENTER LL | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $357.00 | 1780661967 - CJ ELMWOOD PARTNERS L P | 911793912 - CJ ELMWOOD PARTNERS L P | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $983.00 | 1720530405 - GRAND RAPIDS SURGICAL SUITES LLC | 811321919 - (MI) GRAND RAPIDS SURGICAL SUITES, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $1064.00 | 1265466288 - TAMARAC SURGERY CENTER LLC, THE SURGERY CENTER OF FT LAUDERDALE | 650963549 - (FL) TAMARAC SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $543.00 | 1356429765 - ASC OF GEORGIA DERMATOLOGIC SURGERY, ASC OF BAUCOM & MINA DERM SURGERY | 550892029 - (GA) ASC OF GEORGIA DERMATOLOGIC SURGERY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $477.00 | 1043473390 - LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP | 952858745 - (CA) LAKEWOOD EYE PHYSICIANS & SURGEONS, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38746 | $2225.00 | 1508197039 - FREEMAN SURGICAL CENTER LLC | 431704371 - FREEMAN HEALTH SYSTEM | MO | 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 38746 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38746 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 38746 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 |
|---|---|---|
| 38531-CPT | Moderate | Biopsy Or Excision Of Lymph Node(S); Open Inguinofemoral Node(S) |
| 38573-CPT | High | Laparoscopy Surgical; With Bilateral Total Pelviclymphadenectomy And Peri-Aortic Lymph Node Sampling Peritoneal Washings Peritoneal Biopsy(Ies) Omentectomy And Diaphragmatic Washings Including Diaphragmatic And Other Serosal Biopsy(Ies) When Performed |
| 38746-CPT | Moderate | Thoracic Lymphadenectomy By Thoracotomy, Mediastinal And Regional Lymphadenectomy (List Separately In Addition To Code For Primary Procedure) |
| 38747-CPT | Moderate | Abdominal Lymphadenectomy, Regional, Including Celiac, Gastric, Portal, Peripancreatic, With Or Without Para-Aortic And Vena Caval Nodes (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 38746. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38746 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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