CPT 39402 Mediastinoscopy Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 39402: Mediastinoscopy with Mediastinal Lymph Node Biopsy

CPT code 39402 represents mediastinoscopy with excision of one or more mediastinal lymph nodes for diagnostic analysis, most often performed to stage or diagnose thoracic malignancies. The procedure is clinically significant nationwide because it provides tissue diagnosis and staging information that guides oncologic treatment decisions and impacts surgical and systemic therapy planning. Payers commonly covering this service in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of clinical context and the typical settings where the service is performed, plus benchmarking information where available, relevant policy and coverage considerations, and coding guidance for accurate claim submission. The publication highlights common billing practice features such as typical sites of service (operating room or procedural suite via a small lower neck or upper chest incision) and the role of the procedure in cancer staging. Data not available in the input is noted where applicable. The content supports billing, clinical, and policy stakeholders in understanding how CPT code 39402 fits into diagnostic pathways and payer coverage frameworks at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare39402CPTmediastinoscopylymph-node-biopsythoracic-surgeryoncology-diagnosticsprocedural-coding

Billing Code Overview

CPT code 39402 describes a mediastinoscopy with removal of one or more lymph nodes. The procedure involves inserting a thin rigid or flexible tubular instrument through a small incision in the lower neck or upper chest to visualize the mediastinum — the central part of the chest cavity between and in front of the lungs — and to excise lymph nodes for diagnostic analysis, commonly to determine the type and extent or severity of cancer.

Service type: Surgical diagnostic procedure (mediastinoscopy with lymph node biopsy)
Typical site of service: Operating room or procedural suite, with the incision located in the lower neck or upper chest

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a persistent cough, unexplained mediastinal lymphadenopathy on chest CT, and a prior abnormal PET scan is referred for diagnostic evaluation. The thoracic surgeon or interventional pulmonologist performs a mediastinoscopy under general anesthesia using a small incision above the sternal notch. The provider inserts a rigid mediastinoscope to visualize the mediastinal space and obtains targeted lymph node biopsies for histopathology and staging to determine malignancy type and extent. Intraoperative steps include airway management, sterile preparation of the lower neck, a small transverse cervical incision, dissection to the pretracheal space, insertion of the mediastinoscope, identification of nodal stations, excisional or incisional removal of one or more lymph nodes, hemostasis, specimen handling for pathology, and wound closure. Typical perioperative documentation includes indication, informed consent, anesthesia record, number and stations of lymph nodes sampled, specimen labeling, estimated blood loss, and post-anesthesia recovery instructions. Typical site of service is an inpatient operating room or ambulatory surgery center depending on comorbidity and anesthesia needs.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (standard)	Use when no special modifier applies and service is billed as reported.

CPT 39401: Mediastinoscopy with Excisional Biopsy

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Taxonomy Code	Specialty	Notes
2084P0800X	Thoracic Surgery	Primary specialty performing mediastinoscopy for diagnostic/staging lymph node excision.
207T00000X	General Surgery	General surgeons with thoracic practice may perform this procedure.
2085R0203X	Pulmonary Disease (Interventional Pulmonology)	Interventional pulmonologists perform mediastinoscopy or mediastinal biopsies via rigid or flexible approaches.
363L00000X	Pathology	Pathologists receive and interpret lymph node specimens; included as related provider team.
207L00000X	Otolaryngology	Head and neck surgeons may perform cervical mediastinoscopy approaches in select cases.
Taxonomy Code	Specialty	Notes
---	---	---
Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Lung cancer frequently requires mediastinal lymph node sampling for staging.
`C77.9`	Secondary and unspecified malignant neoplasm of lymph nodes	Mediastinal nodes suspicious for metastasis are a direct indication for biopsy.
`R91.8`	Other nonspecific abnormal findings of lung field	Incidental mediastinal lymphadenopathy on imaging may prompt mediastinoscopy for diagnosis.
`R91.1`	Solitary pulmonary nodule	Assessment often includes mediastinal staging if malignancy is suspected.
`C78.00`	Secondary malignant neoplasm of unspecified lung	Evaluation of mediastinal nodes assists in determining primary versus metastatic disease.
`D86.2`	Sarcoidosis of lung	Nonmalignant causes of mediastinal adenopathy sometimes require tissue diagnosis.
`I97.7`	Postprocedural respiratory complications	Listed as a possible postoperative diagnosis to document complications when they occur.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`39400`	Diagnostic mediastinoscopy, including biopsy, when performed	Closely related; may represent a more limited diagnostic mediastinal exploration or alternative coding based on extent.
`32663`	Thoracoscopy, surgical; with excision of mediastinal tumor, including mediastinal lymphadenectomy	Related for procedures using thoracoscopic approach to access mediastinal nodes or masses when thoracoscopy is performed instead of cervical mediastinoscopy.
`32405`	Thoracotomy, with exploration and biopsy of lung and/or pleura; with excision or biopsy of mediastinal lymph nodes	Related when an open thoracotomy is required for mediastinal node biopsy or concurrent pulmonary procedures.
`99223`	Initial hospital care, typically 70 minutes or more, per day, for the evaluation and management of a patient	Preoperative or postoperative inpatient evaluation commonly billed by the attending surgeon in the hospitalization that includes mediastinoscopy.
`88305`	Level IV surgical pathology, gross and microscopic examination	Used by pathology for processing and reporting of lymph node biopsy specimens obtained during this procedure.

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