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Billing code 38381: Thoracic duct ligationMedicare rate & RVUs

Thoracic duct ligation through a thoracic approach controls leakage, commonly chyle leakage, when the duct must be surgically tied off.

CMS RVU26DEffective Oct 1, 2026109 payment localities179 Medicare services in 2024

Medicare pays $771.56 for 38381 nationally in a facility.

Medicare rate · 38381

Thoracic duct ligation

Swap in your local Medicare rate.

Work RVUs
13.05
Total RVUs
23.10
Global days
090

National rate · 2026

$771.56

Facility setting, before claim adjustments.

See every locality for 38381 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 38381 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 38381 covers

The surgeon identifies and ties off the thoracic duct through a thoracic approach, typically to control chyle leakage into the chest. This may be performed by a thoracic or general surgeon in a hospital operating room, including during treatment of a postoperative duct injury or persistent chylothorax. The key distinction is ligation through the chest, rather than a cervical approach or repair of a duct defect.

Report the code when the operative documentation supports thoracic-approach ligation of the thoracic duct; describe the approach, the duct treated, and the reason for ligation. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 38381 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

38381 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$696.47
Alaska*Unavailable$956.21
ArizonaUnavailable$749.04
ArkansasUnavailable$687.35
AtlantaUnavailable$798.07
AustinUnavailable$773.46
BakersfieldUnavailable$759.85
Baltimore/Surr. CntysUnavailable$820.62
BeaumontUnavailable$743.39
BrazoriaUnavailable$749.40

38381 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
38381 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 38381 rate is calculated

Each of 38381’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 · 38381

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.05Practice expense 6.84Malpractice 3.21

23.1000 adjusted RVUs×$33.4009 conversion factor=$771.56

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 38381

38381 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 38381

Thoracic duct ligation

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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 38381

Thoracic duct ligation

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

38381 without 51 · national facility

$771.56

Thoracic duct ligation

38381-51 · Second procedure: 50%

$385.78

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

38381 compared with similar codes

Compare codes

38381 vs 38380 vs 38382 vs 38308: national Medicare rates

Swap in your local Medicare rate.

  • 38381
    Thoracic duct ligation · 13.05 wRVU
    —
  • 38380
    Thoracic duct surgery · 8.25 wRVU
    —
  • 38382
    Thoracic duct ligation · 10.38 wRVU
    —
  • 38308
    Lymphatic surgery · 6.64 wRVU
    —

How to choose

38380Thoracic duct surgery
Both codes describe thoracic duct ligation, but 38380 is the cervical approach and 38381 is the thoracic approach.
38382Thoracic duct ligation
Choose 38382 for repair of the thoracic duct; choose 38381 when the duct is ligated through a thoracic approach.
38308Lymphatic surgery
38308 describes incision of lymph channels. It is not the thoracic duct ligation procedure represented by 38381.

Codes related to 38381

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

Codes related to 38381
CodeHow it relatesNational office range
Same family
38380Thoracic duct surgeryThoracic duct ligation through a cervical rather than thoracic approach.No office rate
38382Thoracic duct ligationThoracic duct repair, distinguished from ligation.No office rate
Used instead
38308Lymphatic surgeryIncision of lymph channels rather than ligation of the thoracic duct.No office rate

38381 billing questions

How does this differ from 38380?

38381 is for thoracic-approach thoracic duct ligation; 38380 is the cervical-approach ligation. The operative approach determines which code fits.

When would 38382 be more appropriate?

Use 38382 when the surgeon repairs the thoracic duct rather than ligating it. The operative report should distinguish repair from tying off the duct.

Is modifier 50 appropriate for bilateral work?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

How does the global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What happens when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

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 38381PPRRVU2026_Oct_nonQPP.csv, line 4,739 (RVU26D)

Open CMS sourceHow we calculate rates

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