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See a sample rate comparisonCPT 38900 Fee Schedule
Last Verified: October 2026
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.
Sentinel Lymph Node Procedure, Intraoperative Identification (Eg Mapping) Of Sentinel Lymph Node(S) Includes Injection Of Non-Radioactive Dye When Performed (List Separately In Addition To Code For Primary Procedure)
| 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 | LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $144.96 national non-facility rate (2026) · View Medicare rates for 38900 |
| Medicaid Fee Schedule | $112.97 median of the 8 states in the free preview · View Medicaid rates for 38900 |
National average reimbursement for CPT 38900 by major payers:
$209.82
$190.34
$192.22
$234.74
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CPT 38900
5 of 25 sample ratesHigher to lower in this preview
Lone Star Endoscopy Center, LLC, Lone Star Endoscopy Southlake
$1,301.00Published rateThe Pagosa Medical Group LLC
$398.64Published rateMandy Peng
University Physicians Incorporated
$378.14Published rateWanda Good
Mountain View Surgical Associates
$228.33Published rateBelmar Womens Care P.C.
Belmar Womens Care PC
$160.39Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 38900 vs. Other Surgical Procedures on the Hemic and Lymphatic Systems Codes
The CPT 38900 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 38900 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 |
|---|---|---|
| 38790-CPT | Low | Injection Procedure For Lymphangiography |
| 38792-CPT | Low | Inject Proc; Radioactive Tracer For Id Of Sentinel, Injection Procedure; Radioactive Tracer For Identification Of Sentinel |
| 38900-CPT | Moderate | Sentinel Lymph Node Procedure, Intraoperative Identification (Eg Mapping) Of Sentinel Lymph Node(S) Includes Injection Of Non-Radioactive Dye When Performed (List Separately In Addition To Code For Primary Procedure) |
| 38999-CPT | High | Unlisted Proc Hemic Or Lymphatic System, Unlisted Procedure Hemic Or Lymphatic System |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 38900. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 38900 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for billing and for communicating services between providers, patients, and payers, ensuring consistent identification of procedures across the healthcare system.
To find out the cost of a medical procedure, you can start by contacting your healthcare provider's billing department for an estimate. For more specific and localized pricing information, especially comparing different providers or understanding insurer-specific rates, it's highly recommended to use tools designed for this purpose. You can utilize Payerprice's fee schedule lookup tool, which allows you to search with a CPT code and your specific location to get detailed pricing information relevant to various payers.
CMS (Centers for Medicare & Medicaid Services) is a federal agency that administers government health programs like Medicare and Medicaid. It publishes fee schedules primarily for services covered under these programs. Payerprice, on the other hand, is a private platform that offers a fee schedule lookup tool. It allows users to search with CPT codes and specific locations, providing insights into a broader range of commercial payer rates and market-based pricing, offering a more comprehensive view beyond just government programs.
Medical costs can vary significantly for the same procedure due to several factors, including geographic location, the type of facility (e.g., hospital vs. outpatient clinic), the specific insurance plan and its negotiated rates with providers, the provider's reputation or specialization, and underlying market dynamics. Different insurance companies negotiate different prices with the same providers, and cash prices can also differ greatly. For accurate pricing based on your specific situation, including CPT code and location, Payerprice's fee schedule lookup tool can help illuminate these variations.
To estimate your out-of-pocket costs, you'll need to know the CPT code for the service, your specific insurance plan details (deductible, copay, coinsurance), and where you plan to receive the service. Start by contacting your insurance company or healthcare provider for an estimate. For a more precise understanding of the fee schedule for a CPT code in your specific location, you can utilize Payerprice's fee schedule lookup tool. This will give you a better idea of the underlying cost, which you can then cross-reference with your insurance benefits to calculate your estimated out-of-pocket expense.