No office rate
Choose 38380 for ligation to control leakage; 38381 describes repair of the thoracic duct.
On this page
CMS RVU26D · Effective 2026-10-01
38380 Thoracic duct surgery Medicare reimbursement rates in Alabama
Surgical ligation of the thoracic duct is reported to control a chyle leak, such as persistent chylothorax after thoracic surgery or injury. Compare 38380 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 38380 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$474.30
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Lymphatic surgery
About 38380: Thoracic duct ligation
Surgical ligation of the thoracic duct is reported to control a chyle leak, such as persistent chylothorax after thoracic surgery or injury.
This service involves surgically tying off the thoracic duct to stop lymphatic fluid leakage. Thoracic or general surgeons typically perform it when a persistent chyle leak or chylothorax requires operative control, including after chest surgery or injury. The operative report should identify the duct as the target and describe its ligation; repair or reconstruction of the duct represents a different service.
Report one service for the duct ligation, supported by the operative findings and technique. Medicare assigns 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 other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 38380
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.25 · 53%
- Practice expense (office) RVU5.94 · 38%
- Malpractice RVU1.33 · 9%
148
Medicare services in 2024 · #4571 by national volume
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.
38380 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
38380 captures duct ligation. 38382 is for reconstruction of the thoracic duct, not simply tying it off.
No office rate
38308 concerns incision of lymphatic channels; 38380 is specific to ligating the thoracic duct.
Compare 38380 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$474.30
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 38380 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
4,738
- Code
- 38380
- Physician work
- 8.25
- Practice expense
- 5.94
- Malpractice
- 1.33
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.25 | × 1.000 | 8.2500 |
| Practice expense | 5.94 | × 0.875 | 5.1975 |
| Malpractice | 1.33 | × 0.566 | 0.7528 |
| Total RVUs | 14.2003 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$474.30
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.25 | 1 |
| Practice expense | 5.94 | 0.875 |
| Malpractice | 1.33 | 0.566 |
(8.25 × 1 + 5.94 × 0.875 + 1.33 × 0.566) × $33.4009 = $474.30
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
38380 billing questions
How is ligation distinguished from thoracic duct repair?
Use 38380 when the surgeon ties off the duct to stop leakage. Use 38381 when the duct itself is repaired rather than ligated.
What operative documentation supports 38380?
Document the thoracic duct as the structure treated, the chyle leak or other operative indication, and the ligation performed. A general note of chylothorax treatment without describing duct ligation is not as specific.
Can modifier 50 be reported?
No. The anatomy and service do not support bilateral adjustment, so modifier 50 is inappropriate.
How does the 90-day global period affect related visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,73538300,,Drainage lymph node lesion,A,,2.30,8.42,,3.56,,0.61,11.33,6.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73638305,,Drainage lymph node lesion,A,,6.51,6.46,NA,6.46,,1.74,14.71,14.71,0,090,0.11,0.73,0.16,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73738308,,Incision of lymph channels,A,,6.64,5.25,NA,5.25,,1.51,13.40,13.40,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73838380,,Thoracic duct procedure,A,,8.25,5.94,NA,5.94,,1.33,15.52,15.52,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,73938381,,Thoracic duct procedure,A,,13.05,6.84,NA,6.84,,3.21,23.10,23.10,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74038382,,Thoracic duct procedure,A,,10.38,7.16,NA,7.16,,2.61,20.15,20.15,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74138500,,Biopsy/removal lymph nodes,A,,3.70,6.46,,2.75,,0.90,11.06,7.35,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515