CPT 38530 Internal Mammary Excision Reimbursement | OpenPayer

Summary & Overview

CPT 38530: Internal Mammary Lymph Node Excision or Biopsy

CPT code 38530 represents an open excision or biopsy of lymph nodes in the internal mammary gland performed with a scalpel to obtain tissue for diagnostic pathology. This surgical procedure is clinically important for staging, diagnosing, or directing treatment of thoracic and breast-related disease that involves internal mammary lymph nodes. Nationally, accurate coding of this procedure affects clinical documentation, surgical quality metrics, and appropriate case reporting across hospital and ambulatory surgical settings.

Key payers considered in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical framing of the procedure, coding context, and payer relevance. The publication outlines typical sites of service, common clinical indications, and where this code fits within surgical oncology and thoracic surgery service lines.

This resource provides benchmarks and policy-relevant information where available, flags areas with "Data not available in the input" when specific payer policies or associated taxonomies are not provided, and summarizes practical considerations for coding and documentation. The goal is to give clinicians, coders, and policy analysts a clear, national-level summary of what CPT code 38530 represents and why it matters for clinical and administrative workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 38530internal mammary lymph nodesurgical biopsythoracic surgerypathologyprocedure codingsurgical oncologyambulatory surgeryhospital inpatient

Billing Code Overview

CPT code 38530 describes an open excision or biopsy of lymph nodes in the internal mammary gland performed with a scalpel. This procedure is undertaken to obtain tissue for pathological evaluation to identify or diagnose disease involving the lymph node or adjacent tissues.

Service type: Surgical biopsy / excision

Typical site of service: Hospital operating room or ambulatory surgical center, or other sterile surgical settings appropriate for open thoracic or chest-wall procedures.

Clinical & Coding Specifications

Clinical Context

A 54-year-old female presents with a palpable abnormality and imaging findings of a suspicious internal mammary lymph node on diagnostic mammography and chest MRI. The multidisciplinary breast team recommends an open excisional biopsy of the internal mammary lymph node to obtain tissue for histopathology and immunohistochemistry to stage suspected breast malignancy and to rule out metastatic disease. The patient is evaluated preoperatively in the outpatient surgical clinic; informed consent is obtained, relevant labs and imaging are reviewed, and anesthesia assessment is completed. The procedure is performed in an ambulatory surgical center or hospital operating room under general anesthesia. A thoracic surgeon or breast surgical oncologist makes a small parasternal incision, identifies the internal mammary chain, isolates and excises the targeted lymph node using scalpel dissection with hemostasis, and sends specimens for frozen section and permanent pathology. Postoperative recovery includes standard PACU monitoring, pain control, wound care instructions, and arrangement for pathology follow-up and oncology consultation based on final results.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or routine service	Use when the procedure is the professional service performed without complication or unusual circumstances.

CPT 38520: Deep Cervical (Scalene) Lymph Node Excision

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

CPT 38542: Excision of Deep Jugular/Axillary Lymph Node

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

CPT 38531: Femoral/Inguinal Lymph Node Excision, Lymphadenectomy

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

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

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

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

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Taxonomy Code	Specialty	Notes
207X00000X	Thoracic Surgery	Commonly performs internal mammary node excision for chest wall and breast-related disease.
2080P0222X	Surgical Oncology (Breast)	Breast surgical oncologists commonly perform excisional biopsies of regional nodes.
2086S0122X	General Surgery	General surgeons with breast specialization frequently perform this procedure.
207L00000X	Cardiothoracic Surgery	May be involved when node location requires thoracic expertise.
207T00000X	Vascular Surgery	Occasionally involved when vascular structures are intimately related to the node dissection.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Internal mammary node biopsy for staging or to evaluate suspected metastasis from a known breast primary.
`C50.911`	Malignant neoplasm of unspecified site of left female breast	Same relevance for left-sided breast malignancy and nodal staging.
`C77.3`	Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes	Direct indication for biopsy of internal mammary nodes to confirm metastatic involvement.
`R22.2`	Localized swelling, mass and lump, trunk	Symptom prompting imaging and targeted lymph node biopsy in the internal mammary region.
`D48.6`	Neoplasm of uncertain behavior of other and unspecified sites	Used when lesion pathology is indeterminate and tissue diagnosis is required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19120`	Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, axillary; single	Performed when concurrent excision of a breast lesion or axillary mass is done in the same operative session.
`38500`	Biopsy or excision of lymph node(s); superficial	May be performed for accessible superficial nodes when internal mammary node excision is not required or as a comparative staging procedure.
`38525`	Biopsy or excision of deep axillary lymph nodes	Often performed alongside regional nodal staging when internal mammary nodes are also sampled.
`19307`	Mastectomy, partial (e.g., lumpectomy), with axillary sampling	May be performed in the same episode of care when primary breast tumor resection and nodal staging are required.
`88305`	Pathology, surgical pathology, gross and microscopic examination	Linked to processing and interpretation of the excised lymph node specimen (technical and professional components).

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