$375.64
Use 38500 for open biopsy or removal of superficial lymph nodes. Use 38525 when the operative report documents dissection to deep axillary nodes.
On this page
CMS RVU26D · Effective 2026-10-01
38525 Axillary node biopsy Medicare reimbursement rates in Rhode Island
Open removal or biopsy of deep axillary lymph nodes for diagnostic evaluation or breast cancer staging, including sentinel-node surgery when performed. Compare 38525 office and facility rates across CMS payment localities in Rhode Island.
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 38525 in Rhode Island?
Rhode Island 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
$434.23
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Lymph node surgery
About 38525: Open deep axillary lymph node biopsy
Open removal or biopsy of deep axillary lymph nodes for diagnostic evaluation or breast cancer staging, including sentinel-node surgery when performed.
The surgeon makes an incision and dissects to one or more deep lymph nodes in the armpit, removing tissue for pathologic examination. Breast and general surgeons commonly perform this procedure in an operating room for diagnostic sampling or axillary staging; it is also used to remove a deep axillary sentinel node during breast cancer surgery. The code identifies the open approach and deep axillary location, rather than a superficial node or a needle sample.
Choose the code based on the operative report’s documented approach and node location. Record the side, the deep axillary dissection, and whether nodes were removed for biopsy or staging. When intraoperative sentinel-node identification is performed, report add-on code 38900 as appropriate. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is statutorily restricted; co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 38525
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.27 · 49%
- Practice expense (office) RVU5.01 · 39%
- Malpractice RVU1.61 · 12%
49.9K
Medicare services in 2024 · #782 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.
38525 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$174.44
Use 38505 for percutaneous needle sampling. Use 38525 when the surgeon reaches and removes deep axillary node tissue through an open incision.
$560.25
Both involve open biopsy or removal of deep nodes, but 38510 is for deep cervical nodes; 38525 is for deep axillary nodes.
No office rate
Both describe open node biopsy or removal at a site-specific level. Use 38531 for inguinofemoral nodes, not deep axillary nodes.
Compare 38525 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$434.23
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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 38525 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
4,745
- Code
- 38525
- Physician work
- 6.27
- Practice expense
- 5.01
- Malpractice
- 1.61
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.27 | × 1.019 | 6.3891 |
| Practice expense | 5.01 | × 1.033 | 5.1753 |
| Malpractice | 1.61 | × 0.892 | 1.4361 |
| Total RVUs | 13.0006 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$434.23
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.27 | 1.019 |
| Practice expense | 5.01 | 1.033 |
| Malpractice | 1.61 | 0.892 |
(6.27 × 1.019 + 5.01 × 1.033 + 1.61 × 0.892) × $33.4009 = $434.23
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.
38525 billing questions
How is 38525 different from a superficial axillary node code?
Use 38525 for open biopsy or removal of deep axillary nodes. Code 38500 describes an open procedure on superficial nodes.
Can 38525 be reported with sentinel-node mapping?
When intraoperative sentinel-node identification is performed, add-on code 38900 may be reported with 38525. Document the identification service in the operative report.
Is 38525 reported per lymph node?
The code covers biopsy or removal of one or more deep axillary nodes; the number of nodes alone does not create separate units.
How is bilateral 38525 reported?
For bilateral work, report modifier 50; CMS pays the bilateral procedure at 150%.
Does the 90-day global include related postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be paid for 38525?
Assistant-at-surgery payment is statutorily restricted. CMS does not permit co-surgeon or team-surgery payment for this code.
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.
4,74238505,,Needle biopsy lymph nodes,A,,1.55,3.38,,0.52,,0.17,5.10,2.24,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537