CPT code 38746: Lymph node dissection2026 Medicare rate & RVUs in Virginia
Report this add-on for regional thoracic lymph node dissection, such as mediastinal and peritracheal node removal performed with a primary thoracic operation.
CMS doesn’t publish an office rate for 38746 in Virginia.
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 38746 covers
This service captures regional removal of thoracic lymph nodes, including mediastinal and peritracheal nodes, during a thoracic operation. A thoracic surgeon commonly performs it as part of lung cancer surgery, such as a lobectomy, in a hospital operating room. The lymph node dissection is distinct from the operation that provides access to or removes lung tissue.
Report 38746 only with a qualifying primary procedure; it is not a stand-alone service. The operative report should support that a regional thoracic lymphadenectomy was performed and identify the nodal area or stations addressed. The CMS add-on rule places payment for this service within the primary procedure’s global period. Examples of primary procedures with which it may be reported include open or thoracoscopic lung resection, when the documented work supports the separate add-on.
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 38746 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $211.31 |
| Virginia | Unavailable | $184.92 |
How the 38746 rate is calculated
Each of 38746’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 · 38746
RVUs × geographic indexes × conversion factor
Work4.02
4.02 RVUs× 1.000 GPCI
Practice expense0.81
0.81 RVUs× 1.000 GPCI
Malpractice1.02
1.02 RVUs× 1.000 GPCI
Adjusted RVUs
5.8500
Conversion factor
$33.4009
Medicare rate
$195.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38746
The CMS indicators that decide how 38746 is paid alongside other services.
CMS payment indicators · 38746
Lymph node dissection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
38746 without 80 · national facility
$195.40
Lymph node dissection
38746-80 · Assistant: 16%
$31.26
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
38746 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38747Abdominal lymphadenectomy
- Use 38746 for regional thoracic nodes, such as mediastinal and peritracheal nodes; 38747 is for regional abdominal lymphadenectomy.
- 38745Axillary dissection
- Use 38746 for thoracic nodal dissection. Code 38745 describes complete axillary lymphadenectomy, not removal of thoracic nodes.
- 38792Sentinel node injection
- Code 38792 reports radiotracer identification of a sentinel node. It does not represent regional thoracic lymph node dissection.
38746 billing questions
Can 38746 be billed by itself?
No. It is an add-on code and must be reported with a primary procedure.
What documentation supports reporting 38746?
The operative report should describe the regional thoracic lymph node dissection and identify the nodal area or stations addressed.
Is 38746 included in the lung resection code?
It represents the additional regional lymphadenectomy work and is reported with the primary thoracic procedure when that work was performed and documented.
How does CMS handle the global period?
CMS treats 38746 as an add-on paid within the global period of its primary procedure.
Is 38746 used for abdominal node removal?
No. It is for thoracic regional nodes; 38747 is the related add-on for regional abdominal lymphadenectomy.
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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