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CPT code 38520: Lymph node biopsy, deep cervical with scalene fat pad2026 Medicare rate & RVUs

Reports open sampling or removal of deep cervical lymph nodes together with scalene fat pad excision, commonly for staging or diagnostic evaluation.

CMS RVU26DEffective Oct 1, 2026109 payment localities173 Medicare services in 2024

Medicare pays $440.89 for 38520 nationally in a facility.

Medicare rate · 38520

Lymph node biopsy, deep cervical with scalene fat pad

Office or facility?

Work RVUs
6.85
Total RVUs
13.20
Global days
090

National rate · 2026

$440.89

Facility setting, before claim adjustments.

See every locality for 38520 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 38520 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 38520 covers

This open operation removes deep cervical lymph nodes along with the scalene fat pad, which contains lymphatic tissue. Thoracic or head and neck surgeons may perform it when tissue is needed to evaluate suspected malignancy, including for cancer staging. The work involves surgical exposure and removal of the specified tissue for pathologic examination, rather than needle sampling or removal of a superficial node alone.

Report the code when the operative record supports both open work on deep cervical nodes and excision of the scalene fat pad. Documentation should identify the anatomic site, approach, and tissue removed. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 38520 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

38520 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$399.00
AlaskaUnavailable$543.50
ArizonaUnavailable$428.69
ArkansasUnavailable$393.87
Atlanta, GAUnavailable$454.18
Austin, TXUnavailable$445.09
Bakersfield, CAUnavailable$441.36
Baltimore area, MDUnavailable$468.20
Beaumont, TXUnavailable$422.75
Brazoria, TXUnavailable$430.31

38520 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
38520 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 38520 rate is calculated

Each of 38520’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 38520

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.85

6.85 RVUs× 1.000 GPCI

Practice expense4.86

4.86 RVUs× 1.000 GPCI

Malpractice1.49

1.49 RVUs× 1.000 GPCI

Adjusted RVUs

13.2000

Conversion factor

$33.4009

Medicare rate

$440.89

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 38520

38520 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 38520

Lymph node biopsy, deep cervical with scalene fat pad

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.11/0.73/0.16Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 38520

Lymph node biopsy, deep cervical with scalene fat pad

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

38520 without 50 · national facility

$440.89

Lymph node biopsy, deep cervical with scalene fat pad

38520-50 · Bilateral: 150%

$661.34

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

38520 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 38520

    Lymph node biopsy, deep cervical with scalene fat pad6.85 wRVU

    Not priced

  • 38510

    Lymph node biopsy, open, deep cervical6.57 wRVU

    $551.11

  • 38500

    Lymph node biopsy, open, superficial node3.7 wRVU

    $369.41

  • 38525

    Axillary node biopsy, open, deep axillary nodes6.27 wRVU

    Not priced

How to choose

38510Lymph node biopsyOpen, deep cervical
Choose 38520 when the open deep cervical node procedure also includes scalene fat pad excision. Choose 38510 when that fat pad is not excised.
38500Lymph node biopsyOpen, superficial node
38500 applies to open biopsy or excision of superficial lymph nodes; 38520 is for deep cervical nodes with scalene fat pad excision.
38525Axillary node biopsyOpen, deep axillary nodes
38525 concerns open biopsy or excision of deep axillary nodes. The deep cervical location and scalene fat pad excision distinguish 38520.

Codes related to 38520

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 38520
CodeHow it relatesNational office range
Same family
38510Lymph node biopsy, open, deep cervicalOpen deep cervical node biopsy or excision without scalene fat pad excision.$489.76–$683.42
38500Lymph node biopsy, open, superficial nodeOpen biopsy or excision of superficial lymph nodes.$324.41–$464.43
38525Axillary node biopsy, open, deep axillary nodesOpen biopsy or excision of deep axillary lymph nodes.No office rate
38505Lymph node biopsy, needle, superficial nodeNeedle sampling of lymph nodes rather than open scalene fat pad excision.$151.67–$223.30

38520 billing questions

How does this differ from 38510?

Both involve open biopsy or excision of deep cervical lymph nodes. Use 38520 when the scalene fat pad is also excised; 38510 describes the deep cervical node procedure without that additional work.

Is scalene fat pad excision included?

Yes. Excision of the scalene fat pad is part of the service described by 38520, so it is not separately represented by this code.

Can 38520 be reported bilaterally?

When the procedure is performed bilaterally, CMS identifies modifier 50 and a 150% payment basis. The operative documentation should support work on both sides.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How does CMS handle other procedures performed in the same session?

The highest-valued procedure is paid in full, while other procedures are subject to the standard multiple-procedure reduction.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 38520PPRRVU2026_Oct_nonQPP.csv, line 4,744 (RVU26D)

Open CMS sourceHow we calculate rates

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