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CPT code 38794: Thoracic duct access, duct cannulation2026 Medicare rate & RVUs

Report thoracic duct access and cannulation when a clinician establishes access to the duct, such as for lymphangiography or treatment of a lymphatic leak.

CMS RVU26DEffective Oct 1, 2026109 payment localities119 Medicare services in 2024

Medicare pays $258.52 for 38794 nationally in a facility.

Medicare rate · 38794

Thoracic duct access, duct cannulation

Office or facility?

Work RVUs
4.5
Total RVUs
7.74
Global days
090

National rate · 2026

$258.52

Facility setting, before claim adjustments.

See every locality for 38794 →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 38794 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 38794 covers

This service involves locating and gaining access to the thoracic duct, then cannulating it through a percutaneous or open approach. It is typically performed by an interventional radiologist or surgeon in a facility setting. A common clinical reason is evaluation or treatment planning for a persistent chylous leak, where access to the duct is needed for lymphatic imaging or a subsequent intervention. The code represents duct access and cannulation, not removal of thoracic lymph nodes.

Report the service when the operative or procedure note supports actual thoracic duct cannulation; document the indication, approach, and successful access. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment requires documentation of medical necessity; 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 38794 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

38794 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$239.53
AlaskaUnavailable$331.61
ArizonaUnavailable$253.17
ArkansasUnavailable$237.17
Atlanta, GAUnavailable$263.98
Austin, TXUnavailable$262.06
Bakersfield, CAUnavailable$263.15
Baltimore area, MDUnavailable$271.73
Beaumont, TXUnavailable$249.12
Brazoria, TXUnavailable$255.02

38794 rates by state

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

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Explore a state

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
38794 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 38794 rate is calculated

Each of 38794’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 · 38794

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.50

4.50 RVUs× 1.000 GPCI

Practice expense2.71

2.71 RVUs× 1.000 GPCI

Malpractice0.53

0.53 RVUs× 1.000 GPCI

Adjusted RVUs

7.7400

Conversion factor

$33.4009

Medicare rate

$258.52

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

Payment rules and modifiers for 38794

38794 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 38794

Thoracic duct access, duct cannulation

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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
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 · 38794

Thoracic duct access, duct cannulation

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 51 · payment effect

With and without the modifier

38794 without 51 · national facility

$258.52

Thoracic duct access, duct cannulation

38794-51 · Second procedure: 50%

$129.26

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

38794 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 38794

    Thoracic duct access, duct cannulation4.5 wRVU

    Not priced

  • 38790

    Lymphangiography injection, contrast injection procedure1.26 wRVU

    Not priced

  • 38746

    Lymph node dissection, thoracic regional nodes4.02 wRVU

    Not priced

  • 38792

    Sentinel node injection, radioactive tracer0.63 wRVU

    $82.17

How to choose

38790Lymphangiography injectionContrast injection procedure
Code 38790 describes an injection procedure for lymphangiography. Code 38794 is for establishing access to and cannulating the thoracic duct.
38746Lymph node dissectionThoracic regional nodes
Use 38746 for removal of thoracic lymph nodes. Use 38794 when the service is thoracic duct access and cannulation, not node excision.
38792Sentinel node injectionRadioactive tracer
Code 38792 describes injection for sentinel-node identification. It is not the code for cannulating the thoracic duct.

Codes related to 38794

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

Codes related to 38794
CodeHow it relatesNational office range
Often billed with
38790Lymphangiography injection, contrast injection procedureLymphangiography injection may be part of the same diagnostic workflow as duct access.No office rate
75807Trunk lymphangiography, bilateralThoracic lymphangiography imaging interpretation may accompany duct access when performed.No office rate
Same family
38746Lymph node dissection, thoracic regional nodesA related thoracic lymphatic operation, but it removes lymph nodes rather than cannulating the duct.No office rate

38794 billing questions

How is thoracic duct access different from thoracic lymph node removal?

Code 38794 describes access and cannulation of the thoracic duct. Code 38746 describes removal of thoracic lymph nodes, a different operative service.

Is this code for lymphangiography itself?

It reports access to and cannulation of the thoracic duct. Code 38790 describes an injection procedure for lymphangiography; do not treat the two services as interchangeable.

What documentation supports reporting 38794?

The procedure note should identify the indication, the percutaneous or open approach, and the steps establishing thoracic duct access and cannulation.

Can modifier 50 be used for access to both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy makes modifier 50 unsuitable.

When is an assistant-at-surgery payable?

Assistant-at-surgery payment requires documentation that the assistant was medically necessary. Co-surgeon and team-surgery billing are not permitted.

What postoperative care is included?

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

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 38794PPRRVU2026_Oct_nonQPP.csv, line 4,771 (RVU26D)

Open CMS sourceHow we calculate rates

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