Billing code 38792: Sentinel node injectionMedicare rate & RVUs in Illinois
Reports radioactive tracer injection to localize sentinel lymph nodes, commonly before breast cancer or melanoma surgery and subsequent node removal.
Medicare pays $78.37–$85.71 for 38792 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
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 9 sections
What 38792 covers
This service is the injection of radioactive tracer to help locate sentinel lymph nodes that drain a tumor site. It is commonly used in breast cancer and melanoma care before sentinel node biopsy or excision. A nuclear medicine or radiology clinician, or the surgeon, may perform the injection in a facility or office setting. The injection is distinct from imaging that follows it and from surgical removal of the node.
Report 38792 when the documented service is the radioactive tracer injection for sentinel node localization. The record should identify the injection site, laterality, tracer, and clinical purpose; report a separately performed node biopsy or imaging service with its applicable code. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 applies to bilateral performance and is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery 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 38792 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$78.37 to $85.71
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $85.64 | $30.58 |
| East St. Louis | $79.83 | $29.44 |
| Rest Of Illinois | $78.37 | $28.36 |
| Suburban Chicago | $85.71 | $29.45 |
How the 38792 rate is calculated
Each of 38792’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 · 38792
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.63Practice expense 1.76Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 38792
The CMS indicators that decide how 38792 is paid alongside other services.
CMS payment indicators · 38792
Sentinel node injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
38792 without 50 · national office
$82.17
Sentinel node injection
38792-50 · Bilateral: 150%
$123.26
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).
38792 compared with similar codes
Compare codes
38792 vs 38790 vs 78195 vs 38900 vs 38525: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 38790Lymphangiography injection
- 38790 is an injection for lymphatic imaging, while 38792 injects radioactive tracer specifically to locate sentinel nodes.
- 78195Lymphatic imaging
- 78195 reports lymphatic and node imaging; 38792 reports the radioactive tracer injection, not the imaging.
- 38900Sentinel node mapping
- 38900 reports intraoperative sentinel node mapping with nonradioactive dye when performed. 38792 is for radioactive tracer injection.
- 38525Axillary node biopsy
- 38525 reports open removal of deep axillary nodes; 38792 reports tracer injection for localization, not node removal.
38792 billing questions
How is 38792 different from sentinel node removal?
38792 reports the radioactive tracer injection used to locate the node. Report the appropriate biopsy or excision code separately when the surgeon removes a node.
Does this code report lymphoscintigraphy imaging?
No. It reports the injection procedure; lymphatic and node imaging is a separate service, such as 78195 when performed and supported.
Can 38792 be reported with nonradioactive sentinel node mapping?
It may be reported with 38900 when both radioactive tracer injection and the separately documented nonradioactive intraoperative mapping technique are performed.
When is modifier 50 appropriate?
Use modifier 50 when the injection service is performed bilaterally. CMS pays the bilateral procedure at 150%.
What documentation supports reporting 38792?
Document the tracer injection, injection site and side, and its purpose in localizing sentinel nodes. Identify any separately performed imaging or node excision in the record.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
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
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