No office rate
Use 38381 for thoracic duct ligation through a cervical approach; use this code when the ligation is performed through the chest.
On this page
CMS RVU26D · Effective 2026-10-01
38382 Thoracic duct ligation Medicare reimbursement rates in Alabama
Reports surgical ligation of the thoracic duct through a thoracic approach, commonly to control a persistent chyle leak or chylothorax. Compare 38382 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 38382 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
$605.30
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 38382: Thoracic-approach thoracic duct ligation
Reports surgical ligation of the thoracic duct through a thoracic approach, commonly to control a persistent chyle leak or chylothorax.
This code describes operative ligation of the thoracic duct through the chest. Thoracic or general surgeons may perform it to control a persistent chyle leak, including chylothorax after thoracic surgery or injury. The service involves identifying the duct and securing it to stop chyle flow; it is distinct from repairing the duct or treating a lymph node lesion.
Select the code when the documented operation ligates the thoracic duct using a thoracic approach, rather than a cervical approach. The operative report should identify the duct, the approach, and the ligation performed. CMS assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. 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 multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 38382
- 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 RVU10.38 · 52%
- Practice expense (office) RVU7.16 · 36%
- Malpractice RVU2.61 · 13%
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.
38382 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Code 38380 describes repair of the thoracic duct. This code describes ligation through a thoracic approach.
No office rate
Code 38308 concerns incision of lymphatic channels, not ligation of the thoracic duct through the chest.
Compare 38382 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
$605.30
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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 38382 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
4,740
- Code
- 38382
- Physician work
- 10.38
- Practice expense
- 7.16
- Malpractice
- 2.61
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.38 | × 1.000 | 10.3800 |
| Practice expense | 7.16 | × 0.875 | 6.2650 |
| Malpractice | 2.61 | × 0.566 | 1.4773 |
| Total RVUs | 18.1223 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$605.30
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.38 | 1 |
| Practice expense | 7.16 | 0.875 |
| Malpractice | 2.61 | 0.566 |
(10.38 × 1 + 7.16 × 0.875 + 2.61 × 0.566) × $33.4009 = $605.30
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.
38382 billing questions
How is this code distinguished from 38381?
Both describe thoracic duct ligation, but this code is for a thoracic approach. Code 38381 is for a cervical approach.
When would 38380 be reported instead?
Code 38380 describes repair of the thoracic duct. This code applies when the surgeon ligates the duct through the chest rather than repairing it.
What documentation supports reporting this code?
The operative report should establish that the thoracic duct was ligated and that the surgeon used a thoracic approach. Documentation of a chyle leak alone does not establish the specific procedure.
Does the 90-day global period include postoperative care?
Yes. The global period includes the day-before preoperative visit and related postoperative care for 90 days after the operation.
Can an assistant or co-surgeon be reported?
CMS permits assistant-at-surgery payment. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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.
4,73738308,,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
4,74238505,,Needle biopsy lymph nodes,A,,1.55,3.38,,0.52,,0.17,5.10,2.24,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74338510,,Biopsy/removal lymph nodes,A,,6.57,8.66,,3.48,,1.27,16.50,11.32,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,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