Summary & Overview
CPT 38792: Sentinel Node Mapping with Tracer Injection
CPT code 38792 defines sentinel node mapping by injection of a contrast or radioactive tracer into target tissues with massage to move the tracer into the lymphatic system. The procedure is used to identify sentinel lymph nodes and detect tumor drainage, most commonly in melanoma and breast cancer surgical care. Nationally, this code supports staging and surgical planning that can influence treatment decisions and downstream resource use.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the service, typical sites of care, and an overview of what to expect when this code is billed in surgical oncology workflows. The publication provides benchmarking context where available, notes on common modifiers and billing considerations, and references to related clinical and coding guidance. Service-level implications for operating room scheduling, perioperative coordination, and pathology follow-up are summarized to help billing, revenue cycle, and clinical teams understand how CPT code 38792 fits into cancer surgery episodes.
Data not available in the input for specific payer reimbursement rates, associated taxonomies, and ICD-10 diagnoses are noted where applicable.
Billing Code Overview
CPT code 38792 describes the injection of a contrast agent or radioactive tracer into target tissues with manual massage to promote lymphatic uptake. The procedure is performed to identify the sentinel lymph node and to locate any tumor drainage into that node, most commonly for melanoma or breast cancer.
Service Type: Sentinel node mapping using injected tracer and tissue massage
Typical Site of Service: Outpatient surgical suite or ambulatory surgical center, often performed in conjunction with oncologic surgery for skin or breast malignancies.
Clinical & Coding Specifications
Clinical Context
A 58-year-old female with newly diagnosed invasive ductal carcinoma of the left breast is scheduled for breast-conserving surgery. Preoperatively, the surgical team requests sentinel lymph node mapping to identify the first draining lymph node(s) for targeted biopsy. In the procedural workflow, the nuclear medicine or surgical team injects a small volume of radiotracer or blue dye into the peritumoral or subareolar tissue and massages the site to facilitate lymphatic uptake. Lymphoscintigraphy or intraoperative gamma probe detection is then used to localize the sentinel node. The identified sentinel node(s) are excised and submitted for pathologic evaluation to stage regional nodal involvement and guide adjuvant therapy decisions. Typical site of service is an outpatient surgical suite, ambulatory surgery center, or hospital operating room under local, regional, or general anesthesia. This procedure is commonly performed for breast cancer and for cutaneous malignancies such as melanoma when sentinel node status will affect staging and treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician’s professional portion of a split technical/professional service related to imaging or interpretation |
50 | Bilateral procedure | When sentinel node mapping/injection is performed on both breasts or bilateral primary sites |
51 | Multiple procedures | When this service is billed with other unrelated surgical procedures on the same day and payer requires multiple-procedure reporting |
52 | Reduced services | When the procedure is partially reduced or not completed as planned (e.g., incomplete mapping) |
59 | Distinct procedural service | When the injection/mapping is distinct from another service performed the same day and needs separation from a bundled code |
76 | Repeat procedure by same physician | When the mapping procedure is repeated later the same day by the same provider |
77 | Repeat procedure by another physician | When a second physician repeats the mapping procedure same day |
79 | Unrelated procedure/service by same physician during postoperative period | When the mapping is unrelated to the prior procedure and performed during an existing global period |
91 | Repeat clinical diagnostic laboratory test | Applicable when repeat diagnostic localization studies or tracer injections are required for confirmation (limited use) |
LT | Left side | When procedure is performed on the left breast or left-sided primary site |
RT | Right side | When procedure is performed on the right breast or right-sided primary site |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2085S0102X | Surgical Oncology | Surgeons who perform sentinel node mapping and excision for breast and melanoma |
| 207P00000X | General Surgery | General surgeons performing breast-conserving surgery and sentinel node procedures |
| 208000000X | Radiation Oncology | Often involved in multidisciplinary planning though not directly performing injection |
| 263Q00000X | Nuclear Medicine | Physicians who perform radiotracer injection/lymphoscintigraphy and gamma-probe localization |
| 207L00000X | Plastic Surgery | May participate in oncoplastic resections and sentinel node procedures |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Primary diagnosis indicating breast cancer where sentinel node mapping guides staging and surgical planning |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Primary diagnosis for left-sided breast cancer requiring sentinel node mapping |
C43.9 | Malignant melanoma of skin, unspecified | Cutaneous melanoma is an indication for sentinel node mapping to assess regional nodal involvement |
D03.9 | Melanoma in situ, unspecified | In select cases of high-risk melanoma in situ where mapping is considered |
Z90.11 | Acquired absence of right breast and nipple | Relevant for staging and planning when prior surgery alters lymphatic drainage patterns |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
38792 | Injection for identification of sentinel node(s) (contrast or radioactive tracer) | Primary code describing peritumoral injection and massage to facilitate lymphatic mapping |
38900 | Intraoperative identification or localization of lymph node(s) by radioguidance (e.g., gamma probe) | Often performed intraoperatively immediately after tracer injection to localize sentinel node(s) for excision |
38525 | Biopsy or excision of lymph node(s); open, superficial | Used when sentinel lymph node(s) are surgically excised via an open approach following localization |
19301 | Partial mastectomy, lumpectomy, or excisional biopsy (breast) for malignancy | Common primary breast surgery performed the same operative session as sentinel node mapping and excision |
38530 | Biopsy or excision of lymph node(s); deep axillary node(s) | Performed when deeper axillary nodes are sampled or when sentinel node mapping indicates additional nodal dissection |