CPT 38740 Axillary Lymph Node Excision Reimbursement

CPT code 38740 represents the surgical excision of superficial axillary lymph nodes below the axillary vein, commonly performed for regional management and staging of breast and chest cancers. Nationally, this procedure is a key component of oncologic surgical care, with implications for postoperative surveillance, adjuvant therapy decisions, and potential complications such as lymphedema.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the code, typical sites of service, and a framework for how payers approach coverage and documentation expectations for axillary lymphadenectomy. The publication outlines common billing considerations tied to operative setting, procedure complexity, and postoperative care needs, and highlights benchmarks and policy updates relevant to surgical oncology services. The content also provides guidance on interpreting related service lines and where additional coding or clinical detail may be required.

Data not available in the input: associated taxonomies, specific ICD-10 diagnoses, related codes, and payer-specific reimbursement rates.

Billing Code Overview

CPT code 38740 describes the surgical excision of superficial axillary lymph nodes located below the axillary vein, excluding nodes deep to muscle layers. This procedure is commonly performed as an axillary lymph node dissection in the context of breast or chest malignancy to remove regional lymphatic tissue for staging and local disease control.

Service type: Surgical lymph node excision (axillary lymphadenectomy)
Typical site of service: Operating room or inpatient surgical suite for axillary surgery; may also occur in outpatient surgical centers depending on clinical context and facility capabilities.

Clinical Context

A typical patient is a 52-year-old woman with a newly diagnosed invasive breast carcinoma of the left breast who presents for surgical management. Preoperative staging with sentinel lymph node biopsy suggests axillary nodal involvement; the breast surgeon schedules an axillary lymph node dissection limited to the level I (superficial) nodes below the axillary vein. The procedure is performed in an operating room under general anesthesia. Intraoperative workflow includes confirmation of laterality, regional marking, sterile preparation, an incision in the axillary fold, dissection through subcutaneous tissue to the axillary fascia, identification and excision of superficial (level I) axillary lymph nodes, hemostasis, and layered wound closure. Specimens are labeled and sent to surgical pathology for histologic evaluation and staging. Postoperative care includes pain control, wound care instructions, monitoring for seroma or hematoma, and coordination with oncology for adjuvant therapy planning based on final node status and pathology.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	When the procedure is performed on the left axilla
`RT`	Right side

Taxonomy Code	Specialty	Notes
207Q00000X	General Surgery	Most breast and axillary cancer resections and node dissections are performed by general surgeons with breast surgery expertise
207RG0300X	Surgical Oncology	Surgical oncologists commonly perform axillary lymph node dissections as part of cancer care
207XS0121X	Plastic Surgery	Plastic surgeons may be involved when reconstruction or extensive soft-tissue work is required
2086S0124X	Thoracic Surgery	Thoracic surgeons sometimes participate for tumors involving the chest wall or adjacent structures
207L00000X	Obstetrics & Gynecology (Gynecologic Oncology)	Rarely involved when multidisciplinary management of chest or breast malignancies requires gynecologic oncologist input

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50.912`	Malignant neoplasm of unspecified site of left female breast	Primary indication for axillary lymph node excision to stage and manage breast cancer
`C50.911`	Malignant neoplasm of unspecified site of right female breast	Same clinical relevance for right-sided breast disease requiring axillary staging
`C50.919`	Malignant neoplasm of unspecified site of breast, unspecified	Used when laterality not specified at initial coding; indicates need for axillary node evaluation
`C79.81`	Secondary malignant neoplasm of breast	May prompt axillary node assessment when metastases are present
`D05.90`	Unspecified ductal carcinoma in situ of unspecified breast	In selected cases with microinvasion or surgical planning, axillary sampling may be considered
`R22.31`	Localized swelling, mass and lump, left upper limb	May be used when an axillary mass or node enlargement prompts diagnostic excision
`R22.32`	Localized swelling, mass and lump, right upper limb	Same as above for right-sided axillary masses

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19301`	Partial mastectomy (lumpectomy), partial simple mastectomy for breast cancer	Commonly performed in the same operative session for breast-conserving therapy with axillary node excision
`39100`	Biopsy or excision of an intrathoracic lymph node, open; single node	May be performed if deeper nodal sampling or chest node evaluation is required beyond axillary level I dissection
`38745`	Radical or modified radical axillary dissection (removal of level I and II nodes)	Represents a more extensive procedure when deeper or multiple-level node removal is required compared with limited superficial node excision
`38760`	Injection procedure for sentinel lymph node identification	Performed before or during surgery to identify sentinel nodes and guide extent of axillary dissection
`99499`	Unlisted evaluation and management service	Occasionally used for bundled or atypical perioperative coordination not described by standard E/M codes

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Summary & Overview

CPT 38740: Superficial Axillary Lymph Node Excision