CPT 38500, in plain terms, covers Open biopsy or removal of one or more superficial lymph nodes without a specifically identified node or deep site. CPT 38500 is referenced in 10 tracked payer policy changes from UnitedHealthcare, Regence BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 38500 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 38500 on AAPC
UnitedHealthcare is removing a long list of CPT codes from the applicable-code list of its Outpatient Surgical Procedures site-of-service policy for Exchange plans, and it is also removing the link to the Manipulation Under Anesthesia policy. The change takes effect December 1, 2026. The source does not state a new billing requirement for the removed codes.
Effective December 1, 2026, UMR removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, UMR's site-of-service policy no longer applies, so the practice should update its internal UMR site-of-service and prior authorization lists before that date.
Effective December 1, 2026, UnitedHealthcare removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, the site-of-service policy no longer applies under this UnitedHealthcare commercial policy, so the practice should update its internal site-of-service and prior authorization lists before that date.
Effective November 1, 2026, site of care medical necessity reviews apply to the listed surgical procedures only when they are performed in an outpatient hospital setting. Use of a hospital outpatient department instead of an ambulatory surgery center or physician office may be considered medically necessary when one or more listed criteria are met, such as no geographically accessible in-network ASC that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring or treatment, ASA Physical Status III or higher, or a BMI over 40. Hospital outpatient use is considered not medically necessary when the criteria are not met.
This surgical site of care policy sets criteria for when a hospital outpatient department may be considered medically necessary instead of an ambulatory surgery center or physician office for listed surgical procedures. Hospital outpatient use may be considered medically necessary when one or more criteria are met, such as no qualifying in-network ASC within 25 miles that can provide the necessary care, an ASA Physical Status Classification of III or higher, a body mass index over 40, or a surgery expected to last longer than 3 hours. Use of a hospital outpatient department instead of an ASC or physician office is considered not medically necessary when the criteria are not met. The procedure may require prior authorization separately under its own medical policy.
Independence Blue Cross Medicare Advantage policy MA11.068g has been expanded to add cervical cancer as a medically necessary indication for sentinel lymph node biopsy (SLNB) and mapping, effective April 20, 2026. Billing teams must ensure cervical cancer cases are now recognized as covered rather than experimental/investigational, and verify proper documentation and coding are in place for these procedures.
Independence Blue Cross expanded coverage for Sentinel Lymph Node Biopsy (SLNB) and mapping to include cervical cancer as a medically necessary indication, effective 04/20/2026. Billing teams must recognize cervical cancer diagnoses as covered indications and ensure proper documentation and coding for these procedures.
Policy MA11.068g expands coverage for sentinel lymph node biopsy and mapping in squamous cell carcinoma cases to now include recurrent SCC or SCC with multiple high-risk features (beyond the previous spindle cell variant limitation), effective August 25, 2025. Billing teams must update documentation requirements and clinical criteria to reflect NCCN guideline alignment for SCC risk stratification.
Independence Blue Cross expanded coverage for Sentinel Lymph Node Biopsy (SLNB) and mapping to include squamous cell carcinomas (SCC) beyond spindle cell variants when the tumor is recurrent or diagnosed with multiple high-risk features per NCCN guidelines, effective 08/25/2025. Billing teams must update documentation requirements to capture risk stratification details for SCC cases to support medical necessity.
Aetna considers ProstaScint medically necessary for pre-operative staging of newly diagnosed, biopsy-proven prostate cancer thought to be clinically localized with a moderate to high probability of occult extra-prostatic metastasis, and for staging after prostatectomy or radiation therapy when there is high suspicion of residual cancer or recurrence. The policy also covers Oncoscint for occult colorectal carcinoma and recurrent ovarian cancer, CEA-Scan with CT for recurrent or metastatic colorectal cancer, OctreoScan for neuroendocrine tumors bearing somatostatin receptors, I-131 MIBG imaging and therapy for neuroblastoma and pheochromocytoma or paraganglioma, lymphoscintigraphy with sentinel lymph node biopsy for the cancers it lists, and Lymphoseek (technetium Tc 99m tilmanocept) for locating lymph nodes in members with breast cancer or melanoma who are undergoing surgery to remove tumor-draining lymph nodes. Azedra (iobenguane I-131) is considered medically necessary for adults and adolescents aged 12 years and older with unresectable pheochromocytoma or paraganglioma that has spread beyond the original tumor site and requires systemic anti-cancer therapy. For all other indications, the policy considers these procedures experimental, investigational, or unproven.
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