$350.88
Use 38500 for open biopsy or excision of superficial lymph nodes. This code describes removal of a lesion in the neck or axilla, not a node-sampling service.
On this page
CMS RVU26D · Effective 2026-10-01
38555 Lesion excision Medicare reimbursement rates in Ohio
Reports surgical removal of a lesion in the neck or axilla, such as a cystic lymphatic malformation, rather than biopsy of a lymph node. Compare 38555 office and facility rates across CMS payment localities in Ohio.
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 38555 in Ohio?
Ohio 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
$954.83
1 of 1 localities have a supported rate.
Payment area: Ohio
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 38555: Cervical or axillary lesion excision
Reports surgical removal of a lesion in the neck or axilla, such as a cystic lymphatic malformation, rather than biopsy of a lymph node.
This service involves operative removal of a lesion in the neck or axilla, including a cystic lymphatic malformation. A surgeon performs it in an operating room when the lesion requires excision; it is distinct from taking a sample of a lymph node for diagnosis. The operative report should identify the lesion and site and describe the excision performed.
Report the code when the documented procedure matches the neck-or-axilla lesion service, not when the surgeon only biopsies a lymph node. CMS assigns a 90-day global period: the day-before preoperative visit and related postoperative care during that period are included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 38555
- 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 RVU15.20 · 52%
- Practice expense (office) RVU10.18 · 35%
- Malpractice RVU4.06 · 14%
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.
38555 compared with similar codes
Office rates for Ohio, from the same CMS release.
$160.57
Use 38505 for percutaneous needle biopsy of a lymph node. It does not describe operative removal of a neck or axillary lesion.
No office rate
Use 38542 for exploration or dissection of deep cervical nodes. This code is for lesion removal in the neck or axilla, not deep-node exploration.
Compare 38555 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
Ohio →
Office / nonfacility
Unavailable
Facility
$954.83
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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 38555 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
4,750
- Code
- 38555
- Physician work
- 15.20
- Practice expense
- 10.18
- Malpractice
- 4.06
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.20 | × 1.000 | 15.2000 |
| Practice expense | 10.18 | × 0.913 | 9.2943 |
| Malpractice | 4.06 | × 1.008 | 4.0925 |
| Total RVUs | 28.5868 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$954.83
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.2 | 1 |
| Practice expense | 10.18 | 0.913 |
| Malpractice | 4.06 | 1.008 |
(15.2 × 1 + 10.18 × 0.913 + 4.06 × 1.008) × $33.4009 = $954.83
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.
38555 billing questions
How is this different from a lymph node biopsy?
This code is for removal of a neck or axillary lesion. Use a lymph node biopsy code when the documented service is sampling or excising a node for diagnostic examination.
Is related postoperative care included?
Yes. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can modifier 50 be reported for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are subject to a 50% reduction.
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.
4,74738531,,Open bx/exc inguinofem nodes,A,,6.57,4.75,NA,4.75,,1.63,12.95,12.95,0,090,0.11,0.73,0.16,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74838542,,Explore deep node(s) neck,A,,7.75,4.98,NA,4.98,,1.33,14.06,14.06,0,090,0.11,0.73,0.16,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74938550,,Removal neck/armpit lesion,A,,6.93,6.72,NA,6.72,,1.85,15.50,15.50,0,090,0.11,0.73,0.16,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,75038555,,Removal neck/armpit lesion,A,,15.20,10.18,NA,10.18,,4.06,29.44,29.44,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,75138562,,Removal pelvic lymph nodes,A,,10.78,7.02,NA,7.02,,2.25,20.05,20.05,0,090,0.11,0.73,0.16,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,75238564,,Removal abdomen lymph nodes,A,,11.10,6.26,NA,6.26,,2.47,19.83,19.83,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,75338570,,Laparoscopy lymph node biop,A,,8.28,4.38,NA,4.38,,1.73,14.39,14.39,0,010,0.10,0.80,0.10,3,0,2,2,0,9,49320,33.4009,09,0,99,0.00,0.00,0.00
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703