How much does Medicare pay for CPT 38500?

Medicare allowed an average of $328.99 per service and paid $261.54 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1895.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 38500?

Biopsy or removal of lymph nodes. It was billed 1,035 times to 1,014 Medicare beneficiaries by 56 providers in 2024.

Does 38500 pay differently in an office than a hospital?

Yes. The allowed amount averaged $138.02 in an office setting and $336.66 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 38500 most?

General Surgery, with 473 services from 28 clinicians. Next are Surgical Oncology, Ambulatory Surgical Center, Plastic and Reconstructive Surgery.

CPT 38500

Biopsy or removal of lymph nodes

$328.99Medicare-allowed amount per service, averaged across 1,035 services

Providers submitted

$1895.17

Asking price, not received

Medicare allowed

$328.99

The fee schedule figure

Medicare paid

$261.54

Balance is patient coinsurance

Providers submitted an average of $1895.17 for this code and Medicare allowed $328.99 — 5.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $261.54 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $138.02
Hospital / facility: $336.66

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 40 services were billed in an office setting and 995 in a facility.

Services: 1,035
Beneficiaries: 1,014
Providers billing it: 56
Total allowed: $340,505

What Medicare pays for CPT 38500

Across 1,035 services billed by 56 providers to 1,014 beneficiaries, Medicare allowed an average of $328.99 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 38500

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	473	468	$133.55	28
Surgical Oncology	252	248	$146.23	14
Ambulatory Surgical Center	176	170	$1233.79	8
Plastic and Reconstructive Surgery	52	49	$127.60	2
Interventional Radiology	48	45	$262.52	1
Thoracic Surgery	12	12	$126.47	1
Gynecological Oncology	11	11	$112.64	1
Otolaryngology	11	11	$122.02	1

38500 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	133	$437.52	$344.42	7
South Carolina	101	$125.37	$103.49	4
Indiana	71	$564.38	$471.41	4
Mississippi	58	$344.09	$323.46	4
Pennsylvania	54	$139.58	$111.27	3
California	51	$1247.69	$857.33	2
Oklahoma	49	$149.04	$124.88	2
Alabama	42	$125.57	$103.87	3
Massachusetts	40	$141.03	$111.43	2
Missouri	39	$133.63	$113.04	2
Minnesota	38	$130.79	$112.07	1
Ohio	33	$124.05	$107.13	2
Maryland	30	$1325.06	$1068.88	1
New York	27	$152.84	$111.69	2
North Carolina	26	$121.47	$104.08	2
Texas	25	$161.20	$128.28	1
Michigan	25	$128.92	$104.23	2
Louisiana	24	$151.65	$110.57	1
Delaware	24	$125.86	$100.14	1
Colorado	20	$1349.48	$1065.55	1
New Jersey	18	$134.35	$100.02	1
Arkansas	16	$129.05	$115.66	1
Nebraska	15	$119.02	$106.73	1
Illinois	15	$148.84	$107.17	1
Arizona	14	$193.15	$143.98	1
West Virginia	13	$138.84	$107.95	1
Rhode Island	12	$190.52	$150.30	1
Georgia	11	$125.46	$104.90	1
Virginia	11	$122.02	$100.33	1

Related codes

38525Biopsy or removal of deep lymph nodes of underarm$319.56
38571Removal of lymph nodes of both sides of pelvis$294.23
38505Needle biopsy or removal of surface lymph nodes$95.48
38570Biopsy and removal of lymph nodes of abdominal cavity$220.94

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.