Summary & Overview
CPT 38790: Two‑Stage Lymphangiography with Lymphatic Duct Injection
CPT code 38790 denotes a two-stage lymphangiography procedure involving injection of contrast into lymphatic ducts followed by X‑ray imaging to visualize the lymphatic vessels. This diagnostic imaging code is used for evaluation of lymphatic channel anatomy, obstruction, or leak and is relevant for surgical planning, oncologic staging, and vascular/lymphatic disorder assessment. Nationally, use of lymphangiography is less common than cross-sectional imaging but remains important when detailed lymphatic mapping is required.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 38790, typical settings of service, and common billing considerations. The publication provides benchmarks and rate context where available, highlights relevant policy and coverage considerations affecting utilization, and outlines typical service line implications for radiology and vascular surgery practices.
This summary is intended for billing managers, radiology administrators, and policy analysts seeking a national perspective on the clinical role and billing context of CPT code 38790. Data not available in the input is noted where applicable and omitted from coverage tables.
Billing Code Overview
CPT code 38790 describes a two-stage lymphangiography in which the provider injects dye into the lymphatic ducts and follows with X‑ray imaging to examine vessels of the lymphatic system. This procedure is an imaging-based diagnostic service focused on the lymphatic vasculature.
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Service type: Diagnostic imaging procedure (lymphangiography)
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Typical site of service: Hospital radiology department or outpatient imaging center where fluoroscopic X‑ray and contrast injection can be performed
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old woman with a history of persistent unilateral lower extremity lymphedema and recurrent cellulitis after prior gynecologic cancer surgery. Conservative measures, including compression therapy and physical therapy, have failed to delineate the cause of lymphatic obstruction. The vascular/interventional radiologist schedules a two-stage lymphangiography to identify lymphatic duct anatomy and sites of leakage or obstruction.
Procedure workflow: The patient arrives to an outpatient interventional radiology suite or hospital radiology department. Under sterile conditions and local anesthesia, the provider performs intradermal or intranodal injection of a water-soluble dye or oil-based contrast into the web spaces of the foot or directly into lymph nodes to opacify the lymphatic channels. Fluoroscopic X-ray imaging is performed during and after injection to document lymphatic vessel course, obstruction, or leak. The exam may include multiple spot radiographs, digital subtraction imaging, and delayed imaging to follow contrast progression. Post-procedure monitoring occurs in PACU or same-day observation, with pain control and discharge instructions provided. Typical site of service is an outpatient radiology or interventional radiology suite, or inpatient radiology when performed during a hospital admission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation for the lymphangiography and the facility bills technical component separately. |