CPT 37238
Global 000 ActiveOpen/perq place stent same
CPT 37238 Billing & Documentation Guide
CPT code 37238 (Open/perq place stent same) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 5.89, a non-facility practice expense RVU of 90.91, and a malpractice RVU of 1.24, a total non-facility RVU of 98.04 and facility RVU of 8.11. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $3405.17, though rates vary from $2826.39 to $4619.17 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 37238, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 37238 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 37238 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 37238
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 5.89 | 5.89 |
| Practice Expense RVU | 90.91 | 0.98 |
| Malpractice RVU | 1.24 | 1.24 |
| Total RVU | 98.04 | 8.11 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 37238
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $3819.23 | $264.97 | $3550.25 - $4619.17 | 29 |
| Florida | $3323.95 | $310.2 | $3161.85 - $3462.45 | 3 |
| Georgia | $3143.38 | $277.81 | $2954.64 - $3332.12 | 2 |
| Illinois | $3210.56 | $308.2 | $3033.77 - $3389.96 | 4 |
| Michigan | $3106.28 | $285.77 | $3015.79 - $3196.76 | 2 |
| North Carolina | $3056.23 | $253.74 | $3056.23 - $3056.23 | 1 |
| New York | $3649.86 | $298.88 | $3110.5 - $3896.6 | 5 |
| Ohio | $3010.78 | $268.36 | $3010.78 - $3010.78 | 1 |
| Pennsylvania | $3217.01 | $274.84 | $3023.36 - $3410.65 | 2 |
| Texas | $3225.7 | $268.51 | $2998.4 - $3446.41 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 37238
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 37238 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0075T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 01924 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01925 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01926 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0254T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0553T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 37238
What does CPT code 37238 mean? +
CPT code 37238 represents: Open/perq place stent same. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 37238? +
The 2026 Medicare national average non-facility payment for CPT 37238 is $3405.17. Rates range from $2826.39 to $4619.17 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 37238? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 37238? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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