Billing code 38115: Splenic repairMedicare rate & RVUs in Washington
Reports operative repair of a ruptured spleen, commonly after blunt abdominal trauma, when the surgeon repairs the injured organ rather than removing it.
CMS doesn’t publish an office rate for 38115 in Washington.
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 38115 covers
billing code 38115 represents operative repair of a ruptured spleen, commonly after blunt abdominal trauma, when the surgeon repairs the injured organ instead of removing it. A trauma or general surgeon typically performs the procedure in an operating room during urgent hospital care. The service is directed at treating the splenic injury while retaining the spleen, rather than performing a partial or total splenectomy.
Report the code when the operative report supports repair of the ruptured spleen; documentation should distinguish repair from removal of all or part of the organ. Medicare assigns 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 others at 50%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this single-organ procedure.
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 38115 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,181.37 |
| Seattle (King Cnty) | Unavailable | $1,270.40 |
How the 38115 rate is calculated
Each of 38115’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 · 38115
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.33Practice expense 8.95Malpractice 5.70
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 38115
38115 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 38115
Splenic repair
| 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) | 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. |
| 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 · 38115
Splenic repair
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
38115 without 51 · national facility
$1,201.76
Splenic repair
38115-51 · Second procedure: 50%
$600.88
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%).
38115 compared with similar codes
Compare codes
38115 vs 38100 vs 38101 vs 38120: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 38100Splenectomy
- Choose 38115 for repair of the ruptured spleen; choose 38100 when the entire spleen is removed.
- 38101Splenectomy
- 38101 is for removal of part of the spleen. It does not describe repair of the ruptured organ.
- 38120Splenectomy
- 38120 describes laparoscopic splenectomy. The deciding distinction is removal by laparoscopy versus repair of the rupture under 38115.
38115 billing questions
How does 38115 differ from splenectomy?
Use 38115 when the ruptured spleen is repaired. Use a splenectomy code when all or part of the spleen is removed.
What documentation supports 38115?
The operative report should identify the splenic rupture and document that the surgeon repaired the spleen. It should make clear whether any portion or all of the organ was removed instead.
Should modifier 50 be reported?
No. Medicare's bilateral adjustment does not apply to this single-spleen procedure, and modifier 50 is inappropriate.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are paid at 50% under the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is 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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