Billing code 38555: Lesion excisionMedicare rate & RVUs in Oklahoma
Reports surgical removal of a lesion in the neck or axilla, such as a cystic lymphatic malformation, rather than biopsy of a lymph node.
CMS doesn’t publish an office rate for 38555 in Oklahoma.
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 38555 covers
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.
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 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $916.70 |
How the 38555 rate is calculated
Each of 38555’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 · 38555
RVUs × geographic indexes × conversion factor
Work15.20
15.20 RVUs× 1.000 GPCI
Practice expense10.18
10.18 RVUs× 1.000 GPCI
Malpractice4.06
4.06 RVUs× 1.000 GPCI
Adjusted RVUs
29.4400
Conversion factor
$33.4009
Medicare rate
$983.32
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38555
38555 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 38555
Lesion excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.73/0.16 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 38555
Lesion excision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
38555 without 51 · national facility
$983.32
Lesion excision
38555-51 · Second procedure: 50%
$491.66
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
38555 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38500Lymph node biopsy
- 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.
- 38505Lymph node biopsy
- Use 38505 for percutaneous needle biopsy of a lymph node. It does not describe operative removal of a neck or axillary lesion.
- 38542Node exploration
- 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.
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 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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