Billing code 38520: Lymph node biopsyMedicare rate & RVUs in Oregon
Reports open sampling or removal of deep cervical lymph nodes together with scalene fat pad excision, commonly for staging or diagnostic evaluation.
CMS doesn’t publish an office rate for 38520 in Oregon.
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 38520 covers
This open operation removes deep cervical lymph nodes along with the scalene fat pad, which contains lymphatic tissue. Thoracic or head and neck surgeons may perform it when tissue is needed to evaluate suspected malignancy, including for cancer staging. The work involves surgical exposure and removal of the specified tissue for pathologic examination, rather than needle sampling or removal of a superficial node alone.
Report the code when the operative record supports both open work on deep cervical nodes and excision of the scalene fat pad. Documentation should identify the anatomic site, approach, and tissue removed. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays 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 38520 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $449.83 |
| Rest Of Oregon | Unavailable | $425.46 |
How the 38520 rate is calculated
Each of 38520’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 · 38520
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.85Practice expense 4.86Malpractice 1.49
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 38520
38520 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 38520
Lymph node biopsy
| 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) | 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. |
| 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 · 38520
Lymph node biopsy
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 50 · payment effect
With and without the modifier
38520 without 50 · national facility
$440.89
Lymph node biopsy
38520-50 · Bilateral: 150%
$661.34
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).
38520 compared with similar codes
Compare codes
38520 vs 38510 vs 38500 vs 38525: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 38510Lymph node biopsy
- Choose 38520 when the open deep cervical node procedure also includes scalene fat pad excision. Choose 38510 when that fat pad is not excised.
- 38500Lymph node biopsy
- 38500 applies to open biopsy or excision of superficial lymph nodes; 38520 is for deep cervical nodes with scalene fat pad excision.
- 38525Axillary node biopsy
- 38525 concerns open biopsy or excision of deep axillary nodes. The deep cervical location and scalene fat pad excision distinguish 38520.
38520 billing questions
How does this differ from 38510?
Both involve open biopsy or excision of deep cervical lymph nodes. Use 38520 when the scalene fat pad is also excised; 38510 describes the deep cervical node procedure without that additional work.
Is scalene fat pad excision included?
Yes. Excision of the scalene fat pad is part of the service described by 38520, so it is not separately represented by this code.
Can 38520 be reported bilaterally?
When the procedure is performed bilaterally, CMS identifies modifier 50 and a 150% payment basis. The operative documentation should support work on both sides.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, while other procedures are subject to the standard multiple-procedure 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
Fee sheets
Put 38520 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →