CPT code 38746 designates an add-on surgical procedure for incision of the chest with removal of thoracic and mediastinal lymph nodes, typically performed alongside a primary operative procedure for cancers of the breast, lung, or chest wall. As an add-on code, 38746 captures the additional work and resources associated with targeted lymphadenectomy in the thorax and mediastinum rather than a standalone operation. Nationally, accurate use of this code affects surgical claims, provider documentation, and case-cost accounting for complex oncologic procedures.

Key payers in this treatment area include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is applied, coding considerations tied to its add-on status, and benchmarking context where available. The publication outlines expected sites of service (hospital inpatient and outpatient operating rooms, and select ambulatory surgery centers) and clarifies that the procedure is performed in combination with another primary procedure.

The review provides concise guidance on claims reporting implications of add-on status, documentation elements that support medical necessity for thoracic/mediastinal lymph node removal, and a summary of common modifiers associated with complex surgical episodes. Data not available in the input will be noted as such in relevant sections.