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Billing code 38525: Axillary node biopsyMedicare rate & RVUs

Open removal or biopsy of deep axillary lymph nodes for diagnostic evaluation or breast cancer staging, including sentinel-node surgery when performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities49.9K Medicare services in 2024

Medicare pays $430.54 for 38525 nationally in a facility.

Medicare rate · 38525

Axillary node biopsy

Swap in your local Medicare rate.

Work RVUs
6.27
Total RVUs
12.89
Global days
090

National rate · 2026

$430.54

Facility setting, before claim adjustments.

See every locality for 38525 → · 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 38525 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 38525 covers

The surgeon makes an incision and dissects to one or more deep lymph nodes in the armpit, removing tissue for pathologic examination. Breast and general surgeons commonly perform this procedure in an operating room for diagnostic sampling or axillary staging; it is also used to remove a deep axillary sentinel node during breast cancer surgery. The code identifies the open approach and deep axillary location, rather than a superficial node or a needle sample.

Choose the code based on the operative report’s documented approach and node location. Record the side, the deep axillary dissection, and whether nodes were removed for biopsy or staging. When intraoperative sentinel-node identification is performed, report add-on code 38900 as appropriate. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is statutorily restricted; co-surgeon and team-surgery payment 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 38525 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

38525 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$386.28
Alaska*Unavailable$521.98
ArizonaUnavailable$417.61
ArkansasUnavailable$380.86
AtlantaUnavailable$444.65
AustinUnavailable$434.53
BakersfieldUnavailable$429.55
Baltimore/Surr. CntysUnavailable$458.85
BeaumontUnavailable$411.66
BrazoriaUnavailable$418.88

38525 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
38525 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 38525 rate is calculated

Each of 38525’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 · 38525

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.27Practice expense 5.01Malpractice 1.61

12.8900 adjusted RVUs×$33.4009 conversion factor=$430.54

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

Payment rules and modifiers for 38525

38525 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 38525

Axillary node biopsy

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 · 38525

Axillary node biopsy

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 50 · payment effect

With and without the modifier

38525 without 50 · national facility

$430.54

Axillary node biopsy

38525-50 · Bilateral: 150%

$645.81

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

38525 compared with similar codes

Compare codes

38525 vs 38500 vs 38505 vs 38510 vs 38531: national Medicare rates

Swap in your local Medicare rate.

  • 38525
    Axillary node biopsy · 6.27 wRVU
    —
  • 38500
    Lymph node biopsy · 3.7 wRVU
    $369.41
  • 38505
    Lymph node biopsy · 1.55 wRVU
    $170.34
  • 38510
    Lymph node biopsy · 6.57 wRVU
    $551.11
  • 38531
    Groin node surgery · 6.57 wRVU
    —

How to choose

38500Lymph node biopsy
Use 38500 for open biopsy or removal of superficial lymph nodes. Use 38525 when the operative report documents dissection to deep axillary nodes.
38505Lymph node biopsy
Use 38505 for percutaneous needle sampling. Use 38525 when the surgeon reaches and removes deep axillary node tissue through an open incision.
38510Lymph node biopsy
Both involve open biopsy or removal of deep nodes, but 38510 is for deep cervical nodes; 38525 is for deep axillary nodes.
38531Groin node surgery
Both describe open node biopsy or removal at a site-specific level. Use 38531 for inguinofemoral nodes, not deep axillary nodes.

Codes related to 38525

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

Codes related to 38525
CodeHow it relatesNational office range
Add-on codes
38900Sentinel node mappingAdd-on for intraoperative sentinel-node identification when performed with this procedure.$129.23–$179.70
Used instead
38500Lymph node biopsyOpen biopsy or removal applies to superficial rather than deep nodes.$324.41–$464.43
38505Lymph node biopsyNeedle sampling of a lymph node uses a percutaneous approach.$151.67–$223.30
Same family
38510Lymph node biopsyOpen biopsy or removal of deep cervical rather than deep axillary nodes.$489.76–$683.42
38531Groin node surgeryOpen biopsy or removal at the inguinofemoral rather than axillary site.No office rate
Often billed with
19301Partial mastectomyMay be performed during the same operation as partial mastectomy for breast cancer.No office rate

38525 billing questions

How is 38525 different from a superficial axillary node code?

Use 38525 for open biopsy or removal of deep axillary nodes. Code 38500 describes an open procedure on superficial nodes.

Can 38525 be reported with sentinel-node mapping?

When intraoperative sentinel-node identification is performed, add-on code 38900 may be reported with 38525. Document the identification service in the operative report.

Is 38525 reported per lymph node?

The code covers biopsy or removal of one or more deep axillary nodes; the number of nodes alone does not create separate units.

How is bilateral 38525 reported?

For bilateral work, report modifier 50; CMS pays the bilateral procedure at 150%.

Does the 90-day global include related postoperative care?

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

Can an assistant surgeon or co-surgeon be paid for 38525?

Assistant-at-surgery payment is statutorily restricted. CMS does not permit co-surgeon or team-surgery payment for this code.

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 38525PPRRVU2026_Oct_nonQPP.csv, line 4,745 (RVU26D)

Open CMS sourceHow we calculate rates

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