Billing code 38794: Thoracic duct accessMedicare rate & RVUs in Texas
Report thoracic duct access and cannulation when a clinician establishes access to the duct, such as for lymphangiography or treatment of a lymphatic leak.
CMS doesn’t publish an office rate for 38794 in Texas.
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 38794 covers
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.
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 38794 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $262.06 |
| Beaumont | Unavailable | $249.12 |
| Brazoria | Unavailable | $255.02 |
| Dallas | Unavailable | $257.00 |
| Fort Worth | Unavailable | $256.32 |
| Galveston | Unavailable | $256.05 |
| Houston | Unavailable | $265.75 |
| Rest Of Texas | Unavailable | $252.19 |
How the 38794 rate is calculated
Each of 38794’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 · 38794
RVUs × geographic indexes × conversion factor
Work4.50
4.50 RVUs× 1.000 GPCI
Practice expense2.71
2.71 RVUs× 1.000 GPCI
Malpractice0.53
0.53 RVUs× 1.000 GPCI
Adjusted RVUs
7.7400
Conversion factor
$33.4009
Medicare rate
$258.52
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38794
38794 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 38794
Thoracic duct access
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| 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 · 38794
Thoracic duct access
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 51 · payment effect
With and without the modifier
38794 without 51 · national facility
$258.52
Thoracic duct access
38794-51 · Second procedure: 50%
$129.26
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
38794 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38790Lymphangiography injection
- Code 38790 describes an injection procedure for lymphangiography. Code 38794 is for establishing access to and cannulating the thoracic duct.
- 38746Lymph node dissection
- Use 38746 for removal of thoracic lymph nodes. Use 38794 when the service is thoracic duct access and cannulation, not node excision.
- 38792Sentinel node injection
- Code 38792 describes injection for sentinel-node identification. It is not the code for cannulating the thoracic duct.
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 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
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