CPT 38790 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 50 - Bilateral Procedure • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 38790 by major payers:
$118.79
$153.58
$129.57
$153.34
| 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 38790 | ||||||
United | 38790 | $627.00 | 1124324181 - MANHATTAN ENDOSCOPY CENTER LLC, MANHATTAN ENDO | 271510596 - (NY) MANHATTAN ENDOSCOPY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $1708.00 | 1861913220 - SJV MANAGEMENT, LLC, SOUTH JERSEY VASCULAR SURGERY CENTER | 202273476 - (NJ) SJV MANAGEMENT, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $641.00 | 1780935528 - QUEENS ENDOSCOPY ASC, LLC | 274189294 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $128.00 | 1467580019 - MIDWEST SURGERY CENTER INC | 204139967 - (NE) MIDWEST SURGERY CENTER INC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $200.00 | 1710203427 - HARLINGEN SURGICAL CENTER, LLC, VALLEY EYE SURGERY CENTER | 270561821 - (TX) HARLINGEN SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $110.00 | 1073546875 - STRAND GASTROINTESTINAL ENDOSCOPY CENTER | 571082826 - (SC) STRAND GASTROINTESTINAL ENDOSCOPY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $932.00 | 1982871935 - NORTHERN VIRGINIA SURGERY CENTER LLC | 203502477 - (VA) NORTHERN VIRGINIA SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $75.00 | 1073764106 - FLORIDA EYE CLINIC AMBULATORY SURGICAL CENTER, INC. | 592303141 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $225.00 | 1013539709 - BSC BILTMORE LLC | 850820003 - (AZ) BSC BILTMORE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $331.00 | 1750312435 - CENTRAL ARIZONA ENDOSCOPY LLC | 203643513 - (AZ) CENTRAL ARIZONA ENDOSCOPY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $174.00 | 1932430816 - SURGCENTER OF GREENBELT, LLC | 270408064 - (MD) SURGCENTER OF GREENBELT LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $97.00 | 1740424944 - GASTRO CARE, LLC | 263402953 - (OH) GASTRO CARE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $531.00 | 1912265653 - BRASELTON ENDOSCOPY CENTER, LLC | 453369410 - (GA) BRASELTON ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $200.00 | 1871104836 - CENTER FOR PAIN MANAGEMENT AMBULATORY SURGERY, LTD | 205545259 - (MN) CENTER FOR PAIN MANAGEMENT AMBULATORY SURGERY LTD | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 38790 | $64.00 | 1285664300 - PHYSICIANS OUTPATIENT SURGERY CENTER, LLC | 311649113 - (OH) PHYSICIANS OUTPATIENT SURGERY CENTER LLC | OH | 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 38790 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38790 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 38790 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 |
|---|---|---|
| 38770-CPT | High | Lymphadenectomy Pelvic Unilat |
| 38780-CPT | High | Retroperitoneal Transabdominal Lymphadenectomy, Extensive, Including Pelvic, Aortic, And Renal Nodes (Separate Procedure) |
| 38790-CPT | Low | Injection Procedure For Lymphangiography |
| 38792-CPT | Low | Injection Procedure; Radioactive Tracer For Identification Of Sentinel Node |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38790. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38790 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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