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Billing code 38530: Lymph node biopsyMedicare rate & RVUs

Reports open biopsy or removal of internal mammary lymph node tissue, commonly for surgical staging or evaluation of suspected disease in the chest.

CMS RVU26DEffective Oct 1, 2026109 payment localities273 Medicare services in 2024

Medicare pays $530.74 for 38530 nationally in a facility.

Medicare rate · 38530

Lymph node biopsy

Work RVUs
8.13
Total RVUs
15.89
Global days
090

National rate · 2026

$530.74

Facility setting, before claim adjustments.

See every locality for 38530 →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 38530 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 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

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

109 of 109 payment localities

38530 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$480.59
Alaska*Unavailable$653.83
ArizonaUnavailable$516.21
ArkansasUnavailable$474.43
AtlantaUnavailable$546.33
AustinUnavailable$536.44
BakersfieldUnavailable$532.80
Baltimore/Surr. CntysUnavailable$563.43
BeaumontUnavailable$508.50
BrazoriaUnavailable$518.46

38530 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
38530 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 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

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)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 · 38530

Lymph 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.

  • 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

38530 without 50 · national facility

$530.74

Lymph node biopsy

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).

When to use modifier 50

38530 compared with similar codes

Compare codes · National

4 codes, side by side

  • 38530

    Lymph node biopsy8.13 wRVU

    Not priced

  • 38525

    Axillary node biopsy6.27 wRVU

    Not priced

  • 38510

    Lymph node biopsy6.57 wRVU

    $551.11

  • 38505

    Lymph node biopsy1.55 wRVU

    $170.34

How to choose

38525Axillary node biopsy
Use 38525 for open sampling or removal of deep axillary nodes. This code identifies the internal mammary nodal basin.
38510Lymph node biopsy
Use 38510 for open biopsy or removal of deep cervical nodes; this code is for internal mammary nodes.
38505Lymph node biopsy
38505 describes needle biopsy of a superficial node. This code describes open surgical sampling or removal of internal mammary node tissue.

Codes related to 38530

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

Codes related to 38530
CodeHow it relatesNational office range
Same family
38525Axillary node biopsyOpen biopsy or removal for deep axillary nodes, rather than the internal mammary basin.No office rate
38510Lymph node biopsyOpen biopsy or removal for deep cervical nodes.$489.76–$683.42
38531Groin node surgeryOpen biopsy or excision for inguinofemoral nodes.No office rate
Used instead
38505Lymph node biopsyNeedle sampling of a superficial lymph node, rather than open internal mammary node surgery.$151.67–$223.30
38500Lymph node biopsyOpen biopsy or removal of superficial nodes at a different nodal depth and site.$324.41–$464.43

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% under the stated fee schedule rule.

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
RVUs for 38530PPRRVU2026_Oct_nonQPP.csv, line 4,746 (RVU26D)

Open CMS sourceHow we calculate rates

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