Summary & Overview
CPT 38505: Superficial Lymph Node Excision / Needle Biopsy
CPT code 38505 represents the excision or needle biopsy of a superficial lymph node and is commonly used to obtain tissue for diagnosis of lymphatic or regional disease. Nationally, this code matters because it captures a frequently performed diagnostic surgical procedure that spans multiple settings — physician offices, ambulatory surgical centers, and hospital outpatient departments — and informs utilization, reimbursement, and quality measurement for surgical and oncology services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and common care pathways that lead to use of the code. The publication summarizes billing and coding considerations, common modifiers observed with this service, and how the procedure fits into diagnostic workflows for cancers, infections, and unexplained lymphadenopathy.
The report provides national benchmarks and utilization patterns, highlights policy and coverage considerations that affect payment across major payers, and explains scenarios that commonly trigger use of 38505. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 38505 describes the excision or biopsy of a superficial lymph node using a needle technique. The procedure is performed to obtain tissue for pathologic evaluation to identify or diagnose disease processes involving the lymph node or adjacent tissues.
Service type: Superficial lymph node excision/biopsy (needle technique).
Typical site of service: Ambulatory surgical center, hospital outpatient department, or physician office procedure room, most commonly involving cervical, axillary, or inguinal lymph nodes.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to an outpatient surgical clinic with a single, firm, palpable cervical lymph node that has persisted for three weeks despite antibiotics. The patient reports localized tenderness and low-grade fevers. The clinician performs a focused history and physical exam, orders basic labs and ultrasound of the neck to localize and characterize the node, and determines tissue diagnosis is required. In the procedure room under local anesthesia, the provider performs a superficial lymph node excision/biopsy to obtain tissue for histopathology and microbiology. Specimens are sent for pathology, flow cytometry, and culture as indicated. Post-procedure, the patient is monitored briefly for bleeding or hematoma and receives wound care instructions and follow-up for results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s professional interpretation component for a service that has a technical component (rare for simple node excision) |
50 | Bilateral procedure | When superficial lymph node excisions are performed on both sides in the same session |