HCPCS C9738 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 | • Outpatient PPS • Other Therapeutic Services and Supplies |
| Complexity Level | Low |
National average reimbursement for HCPCS C9738 by major payers:
$92.58
$N/A
$300.78
$95.47
| 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 HCPCS C9738 | ||||||
United | C9738 | $1660.00 | 1033228168 - ST FRANCIS HEALTH LLC, ST FRANCIS HOSPITAL | 475259919 - (GA) ST FRANCIS HEALTH LLC | GA | General Acute Care Hospital (282N00000X) |
United | C9738 | $857.00 | 1467574202 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS COUSHATTA HEALTH CARE CENTER | 720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANA | LA | Critical Access Hospital (282NC0060X) |
United | C9738 | $809.00 | 1538174347 - LCMC HEALTH HOLDINGS INC, EAST JEFFERSON GENERAL HOSPITAL | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | C9738 | $809.00 | 1497792527 - UNIVERSITY HEALTHCARE SYSTEM, L.C., TULANE LAKESIDE HOSPITAL | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | C9738 | $1409.00 | 1801299375 - OCHSNER MEDICAL CENTER, OCHSNER MEDICAL COMPLEX - RIVER PARISHES | 205432782 | LA | Critical Access Hospital (282NC0060X) |
United | C9738 | $2126.00 | 1720589328 - PIEDMONT WALTON HOSPITAL INC | 824194264 - (GA) PIEDMONT WALTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C9738 | $79.00 | 1386603173 - EYE CARE SURGERY CENTER, INC | 721470732 - (LA) EYE CARE SURGERY CENTER INC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C9738 | $723.00 | 1821098286 - TOURO INFIRMARY | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | C9738 | $1860.00 | 1992815195 - OCHSNER BAPTIST MEDICAL CENTER | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | General Acute Care Hospital (282N00000X) |
United | C9738 | $94.00 | 1083601298 - LAHAYE CENTER FOR ADVANCED EYE CARE, APMC, LAHAYE EYE CLINIC | 720988221 - (LA) LAHAYE EYE CLINIC, P.C. | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C9738 | $669.00 | 1972549855 - SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC, LAKE CHARLES MEMORIAL HOSPITAL | 720551963 - (LA) SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC | LA | General Acute Care Hospital (282N00000X) |
United | C9738 | $389.00 | 1740272095 - DODGE COUNTY HOSPITAL AUTHORITY, DODGE COUNTY HOSPITAL | 580625140 - (GA) DODGE COUNTY HOSPITAL AUTHORITY | GA | Rural Acute Care Hospital (282NR1301X) |
United | C9738 | $1349.00 | 1508810565 - REDMOND PARK HOSPITAL, LLC, REDMOND REGIONAL MEDICAL CENTER | 581123037 - (GA) REDMOND PARK HOSPITAL LLC | GA | General Acute Care Hospital (282N00000X) |
United | C9738 | $113.00 | 1649921065 - JOINT REPLACEMENT CENTER OF LOUISIANA | 874022126 - (LA) JOINT REPLACEMENT CENTER OF LOUS | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C9738 | $434.00 | 1114929957 - OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS, LLC, OUTPATIENT SURGERY CENTER FOR SIGHT | 721405960 - (LA) OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS LLC | LA | 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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HCPCS C9738 vs. Other Other Therapeutic Services and Supplies Codes
The HCPCS C9738 code is part of the Outpatient PPS services used for Other Therapeutic Services and Supplies. 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 HCPCS C9738 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 |
|---|---|---|
| C9734-HCPCS | Moderate | Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (MR) guidance |
| C9738-HCPCS | Low | Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure) |
| C9739-HCPCS | Moderate | Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C9738. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C9738 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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