Billing and Coding: Sentinel Lymph Node Biopsy – Medical Policy Article

Medicare covers sentinel lymph node biopsy and related localization procedures for staging malignant tumors, with sentinel node excision reported using CPT codes 38500/38510/38525/38530 and preoperative lymphoscintigraphy reported separately as CPT 78195. Injection procedures are reported with CPT 38792 when performed without lymphoscintigraphy or when the surgeon injects dye, but certain elements (intraoperative use of a handheld probe and injections included in 78195) are not separately reimbursable and several CPTs must be billed with NOS 001; claims must include valid ICD-10 codes, appropriate provider identifiers, and follow ABN modifier and hospital claim form requirements.

"Sentinel lymph node biopsy is covered for identification, removal, and pathologic evaluation of sentinel lymph nodes to stage and assess regional lymph node metastasis for malignant tumors."