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Billing code 38746: Lymph node dissectionMedicare rate & RVUs

Report this add-on for regional thoracic lymph node dissection, such as mediastinal and peritracheal node removal performed with a primary thoracic operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.9K Medicare services in 2024

Medicare pays $195.40 for 38746 nationally in a facility.

Medicare rate · 38746

Lymph node dissection

Work RVUs
4.02
Total RVUs
5.85
Global days
ZZZ

National rate · 2026

$195.40

Facility setting, before claim adjustments.

See every locality for 38746 →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 38746 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 38746 covers

This service captures regional removal of thoracic lymph nodes, including mediastinal and peritracheal nodes, during a thoracic operation. A thoracic surgeon commonly performs it as part of lung cancer surgery, such as a lobectomy, in a hospital operating room. The lymph node dissection is distinct from the operation that provides access to or removes lung tissue.

Report 38746 only with a qualifying primary procedure; it is not a stand-alone service. The operative report should support that a regional thoracic lymphadenectomy was performed and identify the nodal area or stations addressed. The CMS add-on rule places payment for this service within the primary procedure’s global period. Examples of primary procedures with which it may be reported include open or thoracoscopic lung resection, when the documented work supports the separate add-on.

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 38746 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

38746 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$177.23
Alaska*Unavailable$248.99
ArizonaUnavailable$189.65
ArkansasUnavailable$175.06
AtlantaUnavailable$203.08
AustinUnavailable$193.35
BakersfieldUnavailable$187.22
Baltimore/Surr. CntysUnavailable$207.59
BeaumontUnavailable$190.54
BrazoriaUnavailable$188.73

38746 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
38746 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 38746 rate is calculated

Each of 38746’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 · 38746

RVUs × geographic indexes × conversion factor

Work4.02

4.02 RVUs× 1.000 GPCI

Practice expense0.81

0.81 RVUs× 1.000 GPCI

Malpractice1.02

1.02 RVUs× 1.000 GPCI

Adjusted RVUs

5.8500

Conversion factor

$33.4009

Medicare rate

$195.40

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

Payment rules and modifiers for 38746

The CMS indicators that decide how 38746 is paid alongside other services.

CMS payment indicators · 38746

Lymph node dissection

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

38746 without 80 · national facility

$195.40

Lymph node dissection

38746-80 · Assistant: 16%

$31.26

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

38746 compared with similar codes

Compare codes · National

4 codes, side by side

  • 38746

    Lymph node dissection4.02 wRVU

    Not priced

  • 38747

    Abdominal lymphadenectomy4.76 wRVU

    Not priced

  • 38745

    Axillary dissection13.52 wRVU

    Not priced

  • 38792

    Sentinel node injection0.63 wRVU

    $82.17

How to choose

38747Abdominal lymphadenectomy
Use 38746 for regional thoracic nodes, such as mediastinal and peritracheal nodes; 38747 is for regional abdominal lymphadenectomy.
38745Axillary dissection
Use 38746 for thoracic nodal dissection. Code 38745 describes complete axillary lymphadenectomy, not removal of thoracic nodes.
38792Sentinel node injection
Code 38792 reports radiotracer identification of a sentinel node. It does not represent regional thoracic lymph node dissection.

Codes related to 38746

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

Codes related to 38746
CodeHow it relatesNational office range
Primary code
32482BilobectomyOpen lung lobectomy that may be the primary procedure for a documented thoracic lymphadenectomy.No office rate
32663Thoracoscopic lobectomyThoracoscopic lobectomy that may be paired with documented regional thoracic node dissection.No office rate
Same family
38747Abdominal lymphadenectomyRelated regional lymphadenectomy add-on for abdominal rather than thoracic nodes.No office rate

38746 billing questions

Can 38746 be billed by itself?

No. It is an add-on code and must be reported with a primary procedure.

What documentation supports reporting 38746?

The operative report should describe the regional thoracic lymph node dissection and identify the nodal area or stations addressed.

Is 38746 included in the lung resection code?

It represents the additional regional lymphadenectomy work and is reported with the primary thoracic procedure when that work was performed and documented.

How does CMS handle the global period?

CMS treats 38746 as an add-on paid within the global period of its primary procedure.

Is 38746 used for abdominal node removal?

No. It is for thoracic regional nodes; 38747 is the related add-on for regional abdominal lymphadenectomy.

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 38746PPRRVU2026_Oct_nonQPP.csv, line 4,763 (RVU26D)

Open CMS sourceHow we calculate rates

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