CPT code 38530: Lymph node biopsy, internal mammary nodes2026 Medicare rate & RVUs in Oregon
Reports open biopsy or removal of internal mammary lymph node tissue, commonly for surgical staging or evaluation of suspected disease in the chest.
CMS doesn’t publish an office rate for 38530 in Oregon.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 38530 covers
This code describes an open operation to sample or remove one or more internal mammary lymph nodes, located along the internal thoracic vessels behind the anterior chest wall. A surgeon, commonly a breast or thoracic surgeon, performs the procedure in an operating room when tissue from this specific nodal basin is needed for diagnosis or staging. The approach involves surgical exposure, rather than needle sampling or removal of an axillary, cervical, or superficial node.
Choose the code based on the documented internal mammary site and open technique. The operative report should identify the side, nodal basin, approach, and tissue sampled or removed. CMS assigns 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 others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is 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 38530 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland, OR | Unavailable | $542.77 |
| Rest of Oregon | Unavailable | $512.87 |
How the 38530 rate is calculated
Each of 38530’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 · 38530
RVUs × geographic indexes × conversion factor
Work8.13
8.13 RVUs× 1.000 GPCI
Practice expense6.04
6.04 RVUs× 1.000 GPCI
Malpractice1.72
1.72 RVUs× 1.000 GPCI
Adjusted RVUs
15.8900
Conversion factor
$33.4009
Medicare rate
$530.74
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38530
38530 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 38530
Lymph node biopsy, internal mammary nodes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.73/0.16 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 38530
Lymph node biopsy, internal mammary nodes
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
38530 without 50 · national facility
$530.74
Lymph node biopsy, internal mammary nodes
38530-50 · Bilateral: 150%
$796.11
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).
38530 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38525Axillary node biopsyOpen, deep axillary nodes
- Use 38525 for open sampling or removal of deep axillary nodes. This code identifies the internal mammary nodal basin.
- 38510Lymph node biopsyOpen, deep cervical
- Use 38510 for open biopsy or removal of deep cervical nodes; this code is for internal mammary nodes.
- 38505Lymph node biopsyNeedle, superficial node
- 38505 describes needle biopsy of a superficial node. This code describes open surgical sampling or removal of internal mammary node tissue.
38530 billing questions
Can this code describe a needle sample of an internal mammary node?
No. This code describes an open operation; document the surgical approach and the internal mammary site.
What documentation supports this code?
The operative report should establish the internal mammary nodal basin, laterality, open approach, and whether tissue was sampled or removed.
How is bilateral work reported?
CMS identifies this as a bilateral procedure. With modifier 50, payment is 150%.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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
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