No office rate
Use 38525 for open sampling or removal of deep axillary nodes. This code identifies the internal mammary nodal basin.
On this page
CMS RVU26D · Effective 2026-10-01
38530 Lymph node biopsy Medicare reimbursement rates in Pennsylvania
Reports open biopsy or removal of internal mammary lymph node tissue, commonly for surgical staging or evaluation of suspected disease in the chest. Compare 38530 office and facility rates across CMS payment localities in Pennsylvania.
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 38530 in Pennsylvania?
Pennsylvania 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
$511.04–$554.99
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.
Lymphatic surgery
About 38530: Open internal mammary node biopsy
Reports open biopsy or removal of internal mammary lymph node tissue, commonly for surgical staging or evaluation of suspected disease in the chest.
This code describes an open operation to sample or remove one or more internal mammary lymph nodes, located along the internal thoracic vessels behind the anterior chest wall. A surgeon, commonly a breast or thoracic surgeon, performs the procedure in an operating room when tissue from this specific nodal basin is needed for diagnosis or staging. The approach involves surgical exposure, rather than needle sampling or removal of an axillary, cervical, or superficial node.
Choose the code based on the documented internal mammary site and open technique. The operative report should identify the side, nodal basin, approach, and tissue sampled or removed. CMS assigns 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 others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 38530
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU8.13 · 51%
- Practice expense (office) RVU6.04 · 38%
- Malpractice RVU1.72 · 11%
273
Medicare services in 2024 · #4066 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.
38530 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$525.06–$575.11
Use 38510 for open biopsy or removal of deep cervical nodes; this code is for internal mammary nodes.
$160.77–$177.00
38505 describes needle biopsy of a superficial node. This code describes open surgical sampling or removal of internal mammary node tissue.
Compare 38530 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$554.99
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$511.04
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38530 billing questions
Can this code describe a needle sample of an internal mammary node?
No. This code describes an open operation; document the surgical approach and the internal mammary site.
What documentation supports this code?
The operative report should establish the internal mammary nodal basin, laterality, open approach, and whether tissue was sampled or removed.
How is bilateral work reported?
CMS identifies this as a bilateral procedure. With modifier 50, payment is 150% under the stated fee schedule rule.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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.
4,74338510,,Biopsy/removal lymph nodes,A,,6.57,8.66,,3.48,,1.27,16.50,11.32,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74438520,,Biopsy/removal lymph nodes,A,,6.85,4.86,NA,4.86,,1.49,13.20,13.20,0,090,0.11,0.73,0.16,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74538525,,Biopsy/removal lymph nodes,A,,6.27,5.01,NA,5.01,,1.61,12.89,12.89,0,090,0.11,0.73,0.16,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74638530,,Biopsy/removal lymph nodes,A,,8.13,6.04,NA,6.04,,1.72,15.89,15.89,0,090,0.11,0.73,0.16,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74738531,,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