CPT 38520 Deep Cervical Lymph Node Excision Reimbursement | OpenPayer

Summary & Overview

CPT 38520: Deep Cervical (Scalene) Lymph Node Excision

CPT code 38520 represents open surgical excision of deep cervical (neck) lymph nodes and the scalene fat pad, often with submission of tissue for pathological analysis. This procedure is performed for diagnostic evaluation or treatment of tumors in the neck or chest and is an important code for surgical oncology, otolaryngology, and thoracic surgery services nationwide.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The code is relevant to hospital and ambulatory surgical center billing, and it intersects with pathology services when specimens are sent for analysis.

Readers will learn the clinical context and typical care setting for CPT code 38520, common billing and claim considerations tied to surgical lymphadenectomy, and how this code fits into service lines for surgical oncology and head-and-neck procedures. The publication also summarizes payer coverage patterns, common modifiers used with surgical procedures, and where to look for policy updates affecting use and reimbursement. Data not available in the input will be identified explicitly in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 38520lymph node excisionhead and neck surgeryscalene lymphadenectomysurgical oncologyambulatory surgical centerhospital inpatient

Billing Code Overview

CPT code 38520 describes a surgical procedure in which the provider performs an open removal of deep cervical lymph nodes and the scalene fat pad. The procedure may include sending excised tissue to a laboratory for pathological analysis. It is performed as an investigation or treatment for tumors located in the neck or chest.

Service type: Open surgical lymph node excision for diagnostic or therapeutic management of neck or thoracic tumors
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents with a palpable supraclavicular mass and imaging (CT chest/neck and PET-CT) demonstrating suspicious lymphadenopathy in the lower deep cervical and supraclavicular region with concern for metastatic carcinoma of unknown primary. After multidisciplinary review, the surgical team plans an open supraclavicular lymph node dissection with removal of the scalene fat pad to obtain tissue for definitive histopathology and staging. The patient is admitted or scheduled as an outpatient surgical case based on comorbidity and extent of dissection. Preoperative workflow includes history and physical, focused head and neck exam, informed consent documenting risks (bleeding, nerve injury including spinal accessory nerve, pneumothorax), perioperative antibiotics, anesthesia evaluation, and marking of laterality. Intraoperative steps include an open incision in the neck, dissection of deep cervical lymph nodes and scalene fat pad, hemostasis, and specimen labeling and submission to pathology. Postoperative workflow includes monitoring for airway compromise, nerve function assessment, pain control, pathology follow-up for tumor type and staging, and coordination of oncology for adjuvant therapy if malignant disease is confirmed.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard unmodified claim	Use when no modifier is applicable and the service is bilateral/unilateral as reported by the base code.

CPT 38530: Internal Mammary Lymph Node Excision or Biopsy

CPT-38542-EXCISION-DEEP-AXILLARY-JUGULAR-LYMPH-NODE

CPT 38542: Excision of Deep Jugular/Axillary Lymph Node

CPT-38555-CYSTIC-HYGROMA-EXCISION-DEEP-AXILLARY-NECK

CPT 38555: Excision of Cystic Hygroma, Deep Axillary or Neck

CPT-38505-SUPERFICIAL-LYMPH-NODE-EXCISION-NEEDLE-BIOPSY

CPT 38505: Superficial Lymph Node Excision / Needle Biopsy

CPT-38525-DEEP-AXILLARY-LYMPH-NODE-DISSECTION-OPEN

CPT 38525: Open Deep Axillary Lymph Node Dissection

CPT-38531-FEMORAL-INGUINAL-LYMPH-NODE-EXCISION-LYMPHADENECTOMY

CPT 38531: Femoral/Inguinal Lymph Node Excision, Lymphadenectomy

CPT-38500-SUPERFICIAL-LYMPH-NODE-EXCISION-BIOPSY

CPT 38500: Open Excision or Biopsy of Superficial Lymph Node(s)

CPT-38550-EXCISION-CYSTIC-HYGROMA-NECK-ARMPIT

CPT 38550: Excision of Cystic Hygroma, Neck or Axilla

CPT-38510-DEEP-CERVICAL-LYMPH-NODE-EXCISION-BIOPSY

CPT 38510: Open Excision or Biopsy of Deep Cervical Lymph Nodes

Taxonomy Code	Specialty	Notes
2080S0001X	Otolaryngology (ENT)	Common specialty performing neck lymph node dissections for head and neck malignancy.
207L00000X	General Surgery	Performs cervical and thoracic lymphadenectomies for oncologic indications.
2084P0800X	Thoracic Surgery	Involved when chest or supraclavicular nodes extend toward thoracic inlet or combined chest procedures are needed.
2086S0125X	Surgical Oncology	Performs en bloc resections and nodal staging in cancer management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C77.0`	Malignant neoplasm of lymph nodes of head, face and neck	Direct indication for cervical lymphadenectomy for diagnosis, staging, or treatment.
`C79.31`	Secondary malignant neoplasm of brain and cerebral meninges	Example of metastatic disease; neck nodes may be evaluated in workup of metastatic spread (less common primary example).
`C80.1`	Malignant (primary) neoplasm, unspecified site	Used when malignancy is suspected but primary site is not yet identified; nodal excision helps establish diagnosis.
`R59.0`	Localized enlarged lymph nodes	Symptom code that often precipitates diagnostic nodal excision when imaging/biopsy needed.
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Lung primaries can metastasize to supraclavicular nodes; nodal dissection may be part of staging.
`C76.0`	Malignant neoplasm of head, face and neck, overlapping lesion	Used when tumor spans anatomic sites in head and neck requiring nodal sampling.
`D47.9`	Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified	When lymphoproliferative disorder is suspected and excisional biopsy aids diagnosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`38520`	Lymphadenectomy, deep cervical, unilateral or bilateral including scalene fat pad, open	Primary procedure: open removal of deep cervical and scalene lymph nodes for diagnosis or treatment.
`38720`	Exploration, lymphatic channels for laceration or obstruction; open	Performed when lymphatic channel exploration is needed intraoperatively for drainage or repair related to nodal dissection.
`31628`	Thoracoscopy, surgical; with biopsy(ies) or excision(s) of lung nodule(s) or lesion(s) — diagnostic pleural/mediastinal biopsy codes may be used	May be performed when intrathoracic evaluation or biopsy of mediastinal nodes is indicated in same operative setting by thoracic teams.
`38745`	Excision of cyst, fistula or other lesion of neck; complicated or deep	May be reported when concurrent non-nodal deep neck lesion excision is performed during the operation.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy)	Used when intraoperative or preoperative image guidance is used for targeted needle biopsy adjunct to surgical management.
`88305`	Pathology, surgical pathology, gross and microscopic examination, intermediate complexity	Used by pathology to report histologic evaluation of excised lymph node specimens; billed by the pathology provider.

OpenPayer