CPT 38765 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 38765 |
National average reimbursement for CPT 38765 by major payers:
$1,798.20
$1,710.98
$1,730.88
$2,136.02
| 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 38765 | ||||||
United | 38765 | $585.00 | 1255875126 - VIP SURG ASC, LLC, VIP SURGICAL CENTER | 811621842 - (TX) VIP SURG ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $100.00 | 1316375884 - OXON HILL UROLOGY SURGERY CENTER PC | 463746777 - (MD) OXON HILL UROLOGY SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $474.00 | 1568445062 - EYE SURGERY & LASER CENTER OF WISCONSIN LLC | 461222222 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $2575.00 | 1023071560 - MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES, L.P., MEDICAL CITY SURGERY CENTER/FORT WORTH | 621489404 - (TX) MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $644.00 | 1780618801 - PINEY ORCHARD SURGERY CENTER, LLC. | 521938770 - (MD) PINEY ORCHARD SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $4300.00 | 1851338677 - DELAWARE SURGERY CENTER, LLC | 510401940 - (DE) DELAWARE SURGERY CENTER, LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $900.00 | 1588119283 - DOCTORS OUTPATIENT SURGERY CENTER LLC, DOCTORS OUTPATIENT SURGERY CENTER | 364835603 - (NE) DOCTORS OUTPATIENT SURGERY CENTER, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $700.00 | 1245654615 - GEORGIA INTERVENTIONAL PAIN LLC | 464735435 - (GA) GEORGIA INTERVENTIONAL PAIN LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $695.00 | 1093736795 - HATTIESBURG CLINIC PA, AMBULATORY SURGERY CENTER | 640507572 - HATTIESBURG CLINIC, P.A. | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $500.00 | 1750383295 - EYE SURGERY CENTER OF SAINT AUGUSTINE INC | 200127648 - (FL) EYE SURGERY CENTER OF SAINT AUGUSTINE INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $4300.00 | 1982880274 - BURLINGTON COUNTY ENDOSCOPY CENTER LLC | 208205206 - (NJ) BURLINGTON COUNTY ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $2652.00 | 1962626523 - CALLOWAY CREEK SURGERY CENTER LP | 141948102 - (TX) CALLOWAY CREEK SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $343.00 | 1851548655 - CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | 562059693 - (NC) CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $700.00 | 1396141545 - AXIS SURGERY CENTER LLC | 463623155 - (GA) AXIS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38765 | $500.00 | 1538166053 - SOUTHERN OB GYN AMBULATORY SURGERY CENTER, INC | 300070376 - (GA) SOUTHERN OB GYN AMBULATORY SURGERY CENTER INC | GA | 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 38765 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38765 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 38765 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 |
|---|---|---|
| 38530-CPT | Moderate | Biopsy/Exc Internal Mammary Node |
| 38760-CPT | High | Inguinofemoral Lymphadenectomy, Superficial, Including Cloquet's Node (Separate Procedure) |
| 38765-CPT | High | Inguinofemoral Lymphadenectomy, Superficial, In Continuity With Pelvic Lymphadenectomy, Including External Iliac, Hypogastric, And Obturator Nodes (Separate Procedure) |
| 38770-CPT | High | Lymphadenectomy Pelvic Unilat |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38765. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38765 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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