$529.43
Choose 38520 when the open deep cervical node procedure also includes scalene fat pad excision. Choose 38510 when that fat pad is not excised.
On this page
CMS RVU26D · Effective 2026-10-01
38520 Lymph node biopsy Medicare reimbursement rates in Utah
Reports open sampling or removal of deep cervical lymph nodes together with scalene fat pad excision, commonly for staging or diagnostic evaluation. Compare 38520 office and facility rates across CMS payment localities in Utah.
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 38520 in Utah?
Utah 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
$426.08
1 of 1 localities have a supported rate.
Payment area: Utah
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 38520: Deep cervical node biopsy with scalene fat pad excision
Reports open sampling or removal of deep cervical lymph nodes together with scalene fat pad excision, commonly for staging or diagnostic evaluation.
This open operation removes deep cervical lymph nodes along with the scalene fat pad, which contains lymphatic tissue. Thoracic or head and neck surgeons may perform it when tissue is needed to evaluate suspected malignancy, including for cancer staging. The work involves surgical exposure and removal of the specified tissue for pathologic examination, rather than needle sampling or removal of a superficial node alone.
Report the code when the operative record supports both open work on deep cervical nodes and excision of the scalene fat pad. Documentation should identify the anatomic site, approach, and tissue removed. This major surgery has 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 other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 38520
- 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 RVU6.85 · 52%
- Practice expense (office) RVU4.86 · 37%
- Malpractice RVU1.49 · 11%
173
Medicare services in 2024 · #4455 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.
38520 compared with similar codes
Office rates for Utah, from the same CMS release.
$353.40
38500 applies to open biopsy or excision of superficial lymph nodes; 38520 is for deep cervical nodes with scalene fat pad excision.
No office rate
38525 concerns open biopsy or excision of deep axillary nodes. The deep cervical location and scalene fat pad excision distinguish 38520.
Compare 38520 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
Utah →
Office / nonfacility
Unavailable
Facility
$426.08
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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 38520 in Utah.
PPRRVU2026_Oct_nonQPP.csv
4,744
- Code
- 38520
- Physician work
- 6.85
- Practice expense
- 4.86
- Malpractice
- 1.49
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.85 | × 1.000 | 6.8500 |
| Practice expense | 4.86 | × 0.940 | 4.5684 |
| Malpractice | 1.49 | × 0.898 | 1.3380 |
| Total RVUs | 12.7564 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$426.08
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.85 | 1 |
| Practice expense | 4.86 | 0.94 |
| Malpractice | 1.49 | 0.898 |
(6.85 × 1 + 4.86 × 0.94 + 1.49 × 0.898) × $33.4009 = $426.08
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.
38520 billing questions
How does this differ from 38510?
Both involve open biopsy or excision of deep cervical lymph nodes. Use 38520 when the scalene fat pad is also excised; 38510 describes the deep cervical node procedure without that additional work.
Is scalene fat pad excision included?
Yes. Excision of the scalene fat pad is part of the service described by 38520, so it is not separately represented by this code.
Can 38520 be reported bilaterally?
When the procedure is performed bilaterally, CMS identifies modifier 50 and a 150% payment basis. The operative documentation should support work on both sides.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, while other procedures are subject to the standard multiple-procedure reduction.
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.
4,74138500,,Biopsy/removal lymph nodes,A,,3.70,6.46,,2.75,,0.90,11.06,7.35,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,74238505,,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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985