No office rate
Code 38790 describes an injection procedure for lymphangiography. Code 38794 is for establishing access to and cannulating the thoracic duct.
On this page
CMS RVU26D · Effective 2026-10-01
38794 Thoracic duct access Medicare reimbursement rates in Rhode Island
Report thoracic duct access and cannulation when a clinician establishes access to the duct, such as for lymphangiography or treatment of a lymphatic leak. Compare 38794 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 38794 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
$262.45
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.
Lymphatic surgery
About 38794: Thoracic duct access and cannulation
Report thoracic duct access and cannulation when a clinician establishes access to the duct, such as for lymphangiography or treatment of a lymphatic leak.
This service involves locating and gaining access to the thoracic duct, then cannulating it through a percutaneous or open approach. It is typically performed by an interventional radiologist or surgeon in a facility setting. A common clinical reason is evaluation or treatment planning for a persistent chylous leak, where access to the duct is needed for lymphatic imaging or a subsequent intervention. The code represents duct access and cannulation, not removal of thoracic lymph nodes.
Report the service when the operative or procedure note supports actual thoracic duct cannulation; document the indication, approach, and successful access. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 38794
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU4.50 · 58%
- Practice expense (office) RVU2.71 · 35%
- Malpractice RVU0.53 · 7%
119
Medicare services in 2024 · #4747 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.
38794 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Use 38746 for removal of thoracic lymph nodes. Use 38794 when the service is thoracic duct access and cannulation, not node excision.
$84.25
Code 38792 describes injection for sentinel-node identification. It is not the code for cannulating the thoracic duct.
Compare 38794 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
$262.45
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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 38794 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
4,771
- Code
- 38794
- Physician work
- 4.50
- Practice expense
- 2.71
- Malpractice
- 0.53
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.50 | × 1.019 | 4.5855 |
| Practice expense | 2.71 | × 1.033 | 2.7994 |
| Malpractice | 0.53 | × 0.892 | 0.4728 |
| Total RVUs | 7.8577 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$262.45
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.5 | 1.019 |
| Practice expense | 2.71 | 1.033 |
| Malpractice | 0.53 | 0.892 |
(4.5 × 1.019 + 2.71 × 1.033 + 0.53 × 0.892) × $33.4009 = $262.45
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.
38794 billing questions
How is thoracic duct access different from thoracic lymph node removal?
Code 38794 describes access and cannulation of the thoracic duct. Code 38746 describes removal of thoracic lymph nodes, a different operative service.
Is this code for lymphangiography itself?
It reports access to and cannulation of the thoracic duct. Code 38790 describes an injection procedure for lymphangiography; do not treat the two services as interchangeable.
What documentation supports reporting 38794?
The procedure note should identify the indication, the percutaneous or open approach, and the steps establishing thoracic duct access and cannulation.
Can modifier 50 be used for access to both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy makes modifier 50 unsuitable.
When is an assistant-at-surgery payable?
Assistant-at-surgery payment requires documentation that the assistant was medically necessary. Co-surgeon and team-surgery billing are not permitted.
What postoperative care is included?
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.
4,76838780,,Remove abdomen lymph nodes,A,,17.26,8.48,NA,8.48,,3.57,29.31,29.31,0,090,0.11,0.73,0.16,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,76938790,,Inject for lymphatic x-ray,A,,1.26,0.81,NA,0.81,,0.20,2.27,2.27,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,77038792,,Ra tracer id of sentinl node,A,,0.63,1.76,,0.12,,0.07,2.46,0.82,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,77138794,,Access thoracic lymph duct,A,,4.50,2.71,NA,2.71,,0.53,7.74,7.74,0,090,0.11,0.73,0.16,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,77238900,,Io map of sent lymph node,A,,2.44,1.31,,0.65,,0.59,4.34,3.68,0,ZZZ,0.00,0.00,0.00,0,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,77338999,,Unlistd px hemic/lymphtc sys,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,77439000,,Exploration of chest,A,,7.38,5.66,NA,5.66,,1.69,14.73,14.73,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,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