$350.07–$386.29
Both describe open node sampling or removal, but 38531 is specific to inguinofemoral nodes; 38500 applies to superficial nodes at other sites.
On this page
CMS RVU26D · Effective 2026-10-01
38531 Groin node surgery Medicare reimbursement rates in Pennsylvania
Report open surgical sampling or removal of inguinofemoral lymph nodes for diagnostic evaluation or cancer staging when the groin node basin is involved. Compare 38531 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 38531 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
$416.54–$453.50
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.
Lymph node surgery
About 38531: Open inguinofemoral node biopsy or excision
Report open surgical sampling or removal of inguinofemoral lymph nodes for diagnostic evaluation or cancer staging when the groin node basin is involved.
The surgeon makes an incision in the groin to obtain or remove one or more inguinofemoral lymph nodes for diagnostic evaluation or staging. Typical situations include sampling a suspicious groin node or a mapped node during evaluation of vulvar or skin malignancy. General, gynecologic, and surgical oncologists commonly perform the procedure in an operating room. This code represents open node sampling or excision, rather than removal of an entire nodal basin.
Choose the code based on the open approach and inguinofemoral location. The operative report should identify the groin nodal basin and describe the nodes sampled or removed and the reason for the procedure. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 38531
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.57 · 51%
- Practice expense (office) RVU4.75 · 37%
- Malpractice RVU1.63 · 13%
4.2K
Medicare services in 2024 · #1975 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.
38531 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$160.77–$177.00
Use 38505 for needle sampling of a lymph node. Use 38531 when the surgeon obtains or removes the groin node through an open approach.
No office rate
Code 38760 describes a superficial inguinal lymphadenectomy, a broader nodal dissection. Code 38531 describes open sampling or excision of inguinofemoral nodes.
Compare 38531 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
$453.50
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$416.54
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
38531 billing questions
How does this differ from an open superficial-node biopsy elsewhere?
Use this code when the open node procedure is in the inguinofemoral basin. Code 38500 describes open sampling or removal of superficial nodes at other sites.
Can a needle sample of a groin node be reported with this code?
No. Code 38505 describes needle sampling of a lymph node; this code is for an open surgical approach.
Does this code describe a complete inguinal lymphadenectomy?
It describes open sampling or removal of inguinofemoral nodes, not a broad nodal-basin dissection. A more extensive dissection may require a different code based on its extent.
How is bilateral surgery reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays it at 150%.
What documentation supports an assistant-at-surgery claim?
Document the assistant's role and the medical necessity for assistance. CMS payment for an assistant at surgery is limited to cases with documented medical necessity.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
4,74438520,,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
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