CPT 38204
Global XXXBl donor search management
CMS assigns this code a status indicator of "B", meaning it is not separately payable under the Physician Fee Schedule. Payment is bundled into another procedure.
CPT 38204 Billing & Documentation Guide
CPT code 38204 (Bl donor search management) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of XXX. This code uses the Always bundled payment methodology rather than standard RVU-based Physician Fee Schedule pricing. Refer to the methodology notice above for billing implications.
When billing 38204, 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 38204 with related codes; this code has 6 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Bundled code (no separate payment, included in another service)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 0 units of 38204 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
2026 Medicare Reimbursement by State, CPT 38204
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 | $87.87 | $87.87 | $85.37 - $96.28 | 29 |
| Florida | $92.86 | $92.86 | $89.09 - $97.47 | 3 |
| Georgia | $87.01 | $87.01 | $86.01 - $88 | 2 |
| Illinois | $92.32 | $92.32 | $88.9 - $95.78 | 4 |
| Michigan | $88.18 | $88.18 | $85.86 - $90.5 | 2 |
| North Carolina | $82.7 | $82.7 | $82.7 - $82.7 | 1 |
| New York | $93.41 | $93.41 | $83.39 - $99.01 | 5 |
| Ohio | $85.01 | $85.01 | $85.01 - $85.01 | 1 |
| Pennsylvania | $86.96 | $86.96 | $84.64 - $89.28 | 2 |
| Texas | $85.82 | $85.82 | $84.41 - $89.23 | 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 38204
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 38204 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0263T | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
| 0264T | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
| 0265T | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 38204
What does CPT code 38204 mean? +
CPT code 38204 represents: Bl donor search management. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of XXX.
What is the Medicare reimbursement for CPT 38204? +
The 2026 Medicare national average non-facility payment for CPT 38204 is $87.11. Rates range from $80.73 to $116.5 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 38204? +
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 38204? +
This code has 6 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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