No office rate
Use 38101 when the surgeon removes only part of the spleen. Code 38100 requires removal of the entire organ.
On this page
CMS RVU26D · Effective 2026-10-01
38100 Splenectomy Medicare reimbursement rates in New Jersey
Report this code for open operative removal of the entire spleen, such as for traumatic injury or disease requiring complete splenectomy. Compare 38100 office and facility rates across CMS payment localities in New Jersey.
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 38100 in New Jersey?
New Jersey has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1140.33–$1169.15
2 of 2 localities have a supported rate.
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.
General surgery
About 38100: Open total splenectomy
Report this code for open operative removal of the entire spleen, such as for traumatic injury or disease requiring complete splenectomy.
Code 38100 represents an open abdominal operation in which the surgeon removes the spleen in its entirety. It may be performed for splenic trauma when preservation is not feasible, or for a hematologic condition or tumor requiring complete removal. General and trauma surgeons commonly perform it in a hospital operating room; the code distinguishes this approach from laparoscopic splenectomy and partial removal.
Select the code from the operative report’s documented extent and approach: the record should show complete splenic excision through an open operation. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. When another procedure is performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this single-organ service.
CMS billing rules for 38100
- 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 RVU19.06 · 59%
- Practice expense (office) RVU8.29 · 26%
- Malpractice RVU4.80 · 15%
1.2K
Medicare services in 2024 · #2844 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.
38100 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
38102 describes total splenic removal with partial pancreatectomy. Use 38100 when the operative service does not include that pancreatic resection.
No office rate
38120 identifies a laparoscopic splenectomy. Code 38100 is for the open approach.
No office rate
38115 is for repairing a ruptured spleen rather than removing it. Choose based on whether the surgeon repairs and preserves the spleen or performs a splenectomy.
Compare 38100 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.
2 of 2 payment localities
Northern Nj →
Office / nonfacility
Unavailable
Facility
$1169.15
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$1140.33
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38100 billing questions
How does 38100 differ from 38120?
38100 is for an open operation. Use 38120 when the splenectomy is performed laparoscopically.
Can modifier 50 be reported?
No. The bilateral adjustment does not apply because the code describes removal of a single spleen; modifier 50 is inappropriate.
Is routine postoperative care separately reported?
Related postoperative care through day 90 is included in the global period, along with the day-before preoperative visit.
What documentation supports 38100?
The operative report should establish that the entire spleen was removed and that the surgeon used an open approach. It should also identify any additional procedures performed during the same session.
How is splenectomy coded when part of the pancreas is also removed?
Code 38102 describes total splenic removal with partial pancreatectomy. Review the operative report to determine whether that combined service was performed.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, while 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.
4,70037788,,Revascularization penis,A,,22.75,8.03,NA,8.03,,2.93,33.71,33.71,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,70137790,,Penile venous occlusion,A,,8.22,3.95,NA,3.95,,1.07,13.24,13.24,0,090,0.08,0.83,0.09,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,70237799,,Unlisted px vascular surgery,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,70338100,,Removal of spleen total,A,,19.06,8.29,NA,8.29,,4.80,32.15,32.15,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,70438101,,Removal of spleen partial,A,,19.06,8.39,NA,8.39,,5.08,32.53,32.53,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,70538102,,Removal of spleen total,A,,4.67,1.27,NA,1.27,,1.13,7.07,7.07,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,70638115,,Repair of ruptured spleen,A,,21.33,8.95,NA,8.95,,5.70,35.98,35.98,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00