How much does Medicare pay for CPT 38505?

Medicare allowed an average of $95.48 per service and paid $74.38 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $655.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 38505?

Needle biopsy or removal of surface lymph nodes. It was billed 5,565 times to 5,460 Medicare beneficiaries by 351 providers in 2024.

Does 38505 pay differently in an office than a hospital?

Yes. The allowed amount averaged $122.12 in an office setting and $89.18 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 38505 most?

Diagnostic Radiology, with 3,368 services from 221 clinicians. Next are Interventional Radiology, Physician Assistant, Ambulatory Surgical Center.

CPT 38505

Needle biopsy or removal of surface lymph nodes

$95.48Medicare-allowed amount per service, averaged across 5,565 services

Providers submitted

$655.39

Asking price, not received

Medicare allowed

$95.48

The fee schedule figure

Medicare paid

$74.38

Balance is patient coinsurance

Providers submitted an average of $655.39 for this code and Medicare allowed $95.48 — 6.9× 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 $74.38 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $122.12
Hospital / facility: $89.18

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,065 services were billed in an office setting and 4,500 in a facility.

Services: 5,565
Beneficiaries: 5,460
Providers billing it: 351
Total allowed: $531,346

What Medicare pays for CPT 38505

Across 5,565 services billed by 351 providers to 5,460 beneficiaries, Medicare allowed an average of $95.48 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 38505

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	3,368	3,308	$88.10	221
Interventional Radiology	1,142	1,122	$86.35	73
Physician Assistant	760	743	$75.96	42
Ambulatory Surgical Center	93	90	$613.02	4
General Surgery	82	79	$119.00	3
Nurse Practitioner	61	60	$87.88	4
Otolaryngology	17	17	$184.10	1
Interventional Cardiology	15	14	$79.98	1
Undefined Physician type	14	14	$90.98	1
Pulmonary Disease	13	13	$43.41	1

38505 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
California	624	$86.99	$61.75	39
New York	545	$116.62	$77.05	24
Florida	472	$85.01	$64.97	30
Texas	434	$108.27	$85.78	28
Illinois	286	$84.35	$62.21	22
Missouri	242	$70.53	$55.67	15
Pennsylvania	187	$75.79	$58.80	12
Maryland	177	$97.10	$72.67	10
New Jersey	164	$79.03	$57.48	11
Virginia	163	$75.67	$60.02	11
Massachusetts	148	$91.93	$66.44	9
Minnesota	147	$80.77	$61.61	11
Arizona	136	$82.84	$63.18	10
Iowa	122	$74.08	$61.43	7
Tennessee	120	$104.07	$84.09	6
Arkansas	120	$188.40	$169.16	8
North Carolina	108	$105.58	$86.74	4
Indiana	108	$75.94	$61.55	8
New Mexico	101	$99.49	$81.25	5
Nebraska	97	$223.37	$183.86	6
South Carolina	89	$70.68	$57.80	6
Washington	88	$82.01	$62.26	7
Alabama	66	$69.39	$60.36	4
Georgia	59	$76.79	$61.67	4
Ohio	56	$77.01	$62.87	4
West Virginia	50	$74.53	$58.45	4
Kentucky	50	$82.97	$65.18	3
Wisconsin	49	$75.98	$58.05	4
Mississippi	48	$67.15	$55.62	4
Oregon	47	$75.73	$59.81	4
Louisiana	45	$69.36	$57.49	3
Utah	42	$75.55	$62.74	2
South Dakota	41	$68.72	$54.34	2
District of Columbia	40	$90.67	$65.14	3
Oklahoma	39	$66.90	$57.83	3
North Dakota	31	$64.75	$51.52	2
Colorado	30	$623.40	$499.66	1
Michigan	27	$77.46	$53.01	2
Kansas	24	$79.39	$63.38	2
Nevada	23	$69.05	$52.46	2
Idaho	23	$61.62	$52.19	2
Montana	22	$80.39	$56.94	2
Vermont	19	$92.34	$62.19	1
Delaware	19	$82.79	$65.97	1
New Hampshire	15	$77.16	$56.86	1
Connecticut	11	$71.79	$44.97	1
Rhode Island	11	$86.45	$65.74	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
38570Biopsy and removal of lymph nodes of abdominal cavity$220.94
38500Biopsy or removal of lymph nodes$328.99

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.