# Lymph Node Biopsy: Cost, Coverage, and What to Expect

Source: https://ourhealthnetwork.com/procedure-costs/lymph-node-biopsy
Last reviewed: 2026-04-19
Data: CMS Hospital and Outpatient pricing, CPT/HCPCS code mapping

## Quick answer

Medicare pays surgeons about $237 for a lymph node biopsy procedure. Your total bill with facility, anesthesia, and pathology fees typically runs $3,500 to $15,000, depending on setting, variant, and whether it is done as a standalone biopsy or part of a larger cancer surgery.

## What it is

A lymph node biopsy or removal is a surgical procedure where a doctor takes out one or more lymph nodes so a pathologist can examine them under a microscope. Lymph nodes are small, bean-shaped filters scattered throughout your body that trap cancer cells, bacteria, and other abnormal material. When a node is enlarged, abnormal on imaging, or located in a drainage path from a known cancer, your doctor removes it to find out what is going on.

This is not the same as a needle biopsy. A needle biopsy pulls a few cells through a thin needle in a radiology suite. A surgical lymph node biopsy removes the whole node (or several nodes) through an incision, usually in an operating room.

- **Surgery time:** 30 minutes for a simple superficial biopsy; 1 to 2.5 hours for a deep or laparoscopic pelvic procedure
- **Anesthesia:** local with sedation for shallow nodes, general anesthesia for deep axillary or pelvic nodes
- **Hospital stay:** almost always same-day outpatient; rare overnight stay if part of a larger cancer surgery
- **Incision:** 1 to 3 inches for open biopsy; several small keyhole incisions for laparoscopic pelvic removal
- **Pathology turnaround:** preliminary result in 1 to 3 days, full report with special stains in 5 to 10 days

Two variants drive most of the Medicare volume. The more common one (about 78% of cases in the data) is a deep axillary biopsy, typically done to stage breast cancer or investigate unexplained underarm swelling. The other is a laparoscopic pelvic lymph node removal, almost always performed alongside prostate, bladder, or gynecologic cancer surgery. Those two procedures share a category but are very different operations with different recoveries and different billing profiles.

## When it is done

Lymph node biopsy is almost always a diagnostic or staging procedure, not a treatment. Your doctor wants to know what is in the node so they can pick the right next step.

Your doctor may recommend this when:

1. A lymph node is persistently enlarged for more than 4 to 6 weeks with no clear infection
2. You have been diagnosed with breast, melanoma, prostate, or gynecologic cancer and the node is a likely drainage site for spread
3. Imaging (CT, PET, or ultrasound) shows suspicious node features such as irregular shape, loss of normal architecture, or FDG-avidity
4. A needle biopsy was inconclusive and a larger tissue sample is needed
5. Lymphoma is suspected and a whole node is required to assess architecture
6. You have unexplained systemic symptoms like fever, night sweats, or weight loss along with node enlargement

Before going to surgical biopsy, most doctors try less invasive options first, such as fine-needle aspiration or core needle biopsy under ultrasound guidance. Surgical biopsy gets chosen when the needle sample is not enough, when the node is too deep to needle safely, or when a sentinel or pelvic node removal is part of a planned cancer operation.

## What you pay

The number you will see quoted as Medicare's payment for a lymph node biopsy ($237 on average) is the surgeon's professional fee only. It does not include the operating room, anesthesia, or pathology. For patients, the total cost of care is what matters, and that number is very different depending on how you are insured.

Commercial insurance contracts typically pay 2.5x to 4x what Medicare pays for the same work. So a hospital that bills $2,048 on average (the charge amount in this data) might collect $800 to $1,500 from a commercial insurer and about $237 from Medicare for the surgeon component alone. The total bill, including facility and ancillaries, is usually in the $4,000 to $18,000 range commercially.

**If you're on Medicare:**

- Part B covers the surgeon's professional fee at 80% after the annual Part B deductible ($257 in 2025 figure)
- The facility bills Part A if you are admitted, or Part B if it is outpatient (almost all lymph node biopsies are outpatient)
- You owe 20% coinsurance on the Medicare-allowed amount unless you have Medigap, a Medicare Advantage plan with a cap, or Medicaid
- Anesthesia and pathology each have their own Part B claims with their own 20% coinsurance

**If you have commercial insurance:**

- Expect to hit your deductible if you have not already; the biopsy alone often exceeds typical deductibles ($1,500 to $4,000 individual)
- After deductible you usually owe 10% to 30% coinsurance until you hit your out-of-pocket maximum
- Typical patient responsibility is $800 to $3,500 for a standalone biopsy, more if done in a hospital outpatient department
- Prior authorization is common; confirm it is in place before surgery or the claim may be denied

**If you're uninsured or paying cash:**

- Ambulatory surgery centers and hospital financial offices often quote bundled cash-pay rates in the $2,500 to $9,000 range depending on variant and setting
- Hospital charity-care policies frequently waive bills for patients under 200% to 400% of the federal poverty line; ask before the procedure
- Negotiate a single bundled price that includes surgeon, facility, anesthesia, and pathology so a pathologist bill does not surprise you later
- Some cancer centers have grant funding that pays for diagnostic biopsies when cancer is suspected

## Anatomy of the bill

A lymph node biopsy bill is almost never one line item. You will usually see three to five separate charges, sometimes from different organizations that never share a front desk.

**Facility fee:** The charge for using the operating room, recovery room, and nursing staff. This is by far the largest component. Hospital outpatient departments typically bill $2,500 to $8,000; ambulatory surgery centers bill $1,200 to $4,000 for the same procedure. Medicare pays facilities on an ASC or HOPD schedule that is separate from the surgeon payment.

**Surgeon (professional) fee:** What the surgeon charges for performing the procedure. Medicare pays about $237 on average here (the number in the data above); commercial insurers pay roughly 2.5x to 4x that amount.

**Anesthesia fee:** Billed separately by the anesthesiologist or CRNA, usually as a function of case length. Expect $400 to $1,500 commercially depending on anesthesia type and time. Local-only biopsies avoid this entirely; pelvic laparoscopic cases always incur it.

**Pathology fee:** The most overlooked line on the bill. The pathologist reviews each node, sometimes orders special stains or immunohistochemistry, and may bill $200 to $1,200 per node or specimen. If sentinel node staging is done, the count can add up. Ask whether pathology is in-network.

**Imaging and guidance (when used):** Ultrasound or CT guidance adds $300 to $900 commercially. Sentinel node mapping with a radioactive tracer adds a nuclear medicine charge of $500 to $1,500.

**Coverage note:** When this biopsy is ordered to evaluate a suspicious finding, it is diagnostic, not screening. Your preventive benefits usually do not apply. Your deductible and coinsurance will kick in.

## Cost by state

Even looking at surgeon fees alone, what Medicare pays varies by more than 2x depending on where the procedure is done. Delaware is the cheapest state in the data at $122 average payment, while Hawaii is the priciest at $265. Michigan, New York, and Hawaii all sit above the $240 mark, while much of the South and Midwest cluster in the $170 to $200 range. Volume is concentrated in large states: Florida (11,589 services), California (9,271), Texas (6,537), and Illinois (5,934) together account for about 75% of all Medicare lymph node biopsies in the dataset.

These state figures are for the surgeon's professional fee. Facility fees vary by much more, because hospital pricing reflects local commercial market power, cost of living, and the local payer mix.

Why costs vary by state:

- **Medicare GPCI adjustments** raise physician payment in high-cost metros like the Bay Area, New York City, and Hawaii, and lower it in rural states
- **Commercial market concentration:** in states where a single hospital system controls most of the market, commercial prices are often 50% to 100% higher than in competitive markets
- **Cost of living and wages** for surgical staff and facility operations flow through into facility fees
- **State billing and balance-billing laws** (above and beyond the federal No Surprises Act) determine how aggressively out-of-network providers can pursue you

## Office vs facility

Lymph node biopsies are almost always done in a facility setting. Medicare data shows 42,868 services in hospital outpatient or ambulatory surgery centers versus just 1,446 in office settings, about 97% to 3%. The office cases are typically superficial groin or neck nodes that can be handled under local anesthesia in a minor procedure room. Everything axillary, deep, or pelvic goes to a facility operating room because of anesthesia, sterility, and pathology workflow requirements.

So the real cost choice for most patients is not office versus facility. It is hospital outpatient department (HOPD) versus ambulatory surgery center (ASC).

- **Hospital outpatient makes more sense when:** the biopsy is bundled with larger cancer surgery, pathology needs to be reviewed intraoperatively by an on-site team, you have significant heart or lung disease, or you need overnight observation
- **Ambulatory surgery center makes more sense when:** you are otherwise healthy, the biopsy is standalone, and cost is a concern. ASC facility fees are often 40% to 60% lower than HOPD facility fees for the same CPT code. Medicare's ASC payment schedule reflects this gap, and commercial plans usually follow
- **Ask specifically** whether the surgeon has privileges at both and whether your insurer contracts differently with each

## Who performs the procedure

General surgeons perform the largest share of lymph node biopsies, about 56% of Medicare services in this data. Urologists (19%) and surgical oncologists (18%) split most of the rest, with gynecologic oncologists handling a smaller specialized slice. Which specialty handles your case depends mostly on which nodes and why. Axillary biopsies for breast cancer typically go to general or breast surgical oncology; pelvic node dissections during prostate surgery go to urology; pelvic node dissections during gynecologic cancer surgery go to gynecologic oncology.

What to look for when choosing a specialist:

- **Procedure volume:** surgeons who do 50+ of your specific biopsy type per year have lower complication rates
- **Cancer-specific focus:** if the biopsy is for suspected cancer, a surgical oncologist or cancer-center surgeon usually has better staging fluency
- **Board certification** in general surgery, urology, or ob-gyn, plus fellowship training in surgical oncology or gynecologic oncology where relevant
- **Sentinel node experience:** if you need sentinel node mapping for breast cancer or melanoma, ask specifically how many they do each year
- **Facility affiliation:** surgeons who operate at both hospitals and ambulatory surgery centers give you more facility options
- **Pathology partnership:** the biopsy is only useful if interpreted well; ask whether they work with a dedicated cancer pathologist

Physician assistants appear in the data at a much lower average payment ($36) because they are billing as assistants at surgery rather than as primary performers. Do not read that number as a standalone procedure price.

## How to shop for the best price

A lymph node biopsy is one of the more shoppable procedures in cancer workup, because the surgical day is short and the bundle of services is fairly predictable. Pricing ahead of time is realistic.

1. **Request a Good Faith Estimate in writing.** Federal law (since 2022) requires hospitals and most providers to give uninsured or self-pay patients a written estimate. Even if you have insurance, ask for one. If the final bill exceeds it by more than $400, you have dispute rights.
2. **Verify every billing party is in-network.** Surgeon, facility, anesthesiologist, and pathologist all bill separately. Any one of them being out-of-network can triple your share of the bill. Get names in advance and call your plan.
3. **Compare HOPD vs ASC pricing.** Call your insurer's cost tool or member services for the same CPT code (38525 or 38571) at two or three facilities your surgeon uses. The spread is often thousands of dollars for the exact same procedure.
4. **Ask about bundled versus itemized pricing.** Some ASCs and cash-pay programs offer a single price covering surgeon, facility, anesthesia, and pathology. Bundled prices are almost always cheaper than the sum of individual itemized bills.
5. **Apply for financial assistance or a payment plan.** Every nonprofit hospital has a written charity-care policy, often covering patients up to 300% or 400% of the federal poverty line. Ask the billing office before the procedure, not after.
6. **Get a second opinion on whether a surgical biopsy is needed.** Sometimes a repeat needle biopsy, short-interval imaging, or PET scan is the right next step, especially for non-cancer workups. A second opinion can reframe the choice.
7. **Confirm pathology workflow and cost.** Sentinel node cases can generate multiple pathology bills. Ask upfront how many specimens will be processed and whether the pathology group is in-network.

Red flags to watch for: vague phrases like "it depends on what we find," estimates that exclude pathology, or a facility that cannot tell you which anesthesia group covers the OR that day. Any of those mean you are likely to get a surprise bill, and you should push back before the procedure.

## Surprise billing risks

Lymph node biopsies are a classic surprise-bill procedure. The surgeon might be in-network, the hospital might be in-network, but the anesthesiologist or pathologist often is not, and you only find out when the bill arrives. The No Surprises Act (2022) protects you from most out-of-network ancillary billing at in-network facilities, but gaps remain, especially for pathology done by outside labs and for services coded as "independent diagnostic."

Most common surprise-billing sources for this procedure:

- **Anesthesia:** the anesthesiologist or CRNA may contract independently with the hospital and not be in-network with your plan
- **Pathology:** the pathologist reading your slides may work for an outside lab with its own insurance contracts
- **Sentinel node mapping:** the nuclear medicine charge is sometimes billed by a separate radiology group
- **Surgical assistant:** if an assistant surgeon or first-assist PA bills separately, that claim may process out-of-network
- **Facility fee upcoding:** a procedure coded as a higher-complexity case than expected, sometimes appropriately, sometimes not

If you get a surprise bill:

- **Do not pay until verified.** Request an itemized bill with CPT codes and compare to your Explanation of Benefits
- **Invoke the No Surprises Act** for out-of-network providers at an in-network facility. File a complaint at cms.gov/nosurprises or call 1-800-985-3059
- **Contact your state insurance commissioner** if your state has additional balance-billing protections
- **Ask the billing office for a payment plan or charity-care review** while the dispute is pending. You should not be sent to collections during a legitimate dispute

## Total recovery cost

Recovery timing depends entirely on which variant you had. A deep axillary biopsy typically has you back to desk work in 3 to 7 days, with lifting restrictions for 2 to 3 weeks. A laparoscopic pelvic lymph node removal, usually done as part of a larger cancer surgery, carries a longer recovery of 2 to 4 weeks, with driving and work restrictions tied to the main operation. Expect one or two post-op visits in the first month and a pathology review visit where your surgeon or oncologist walks you through the results.

Add-on costs to budget for:

- **Pathology special stains:** $150 to $600 if the initial read requires immunohistochemistry or flow cytometry
- **Follow-up imaging:** if the biopsy is positive for cancer, expect CT or PET staging at $1,200 to $3,500 commercially
- **Post-op visits:** 1 to 2 office visits at $100 to $300 commercial copay each
- **Wound care supplies:** $20 to $75 (gauze, tape, drainage tracking if a drain is placed)
- **Prescription medications:** antibiotics $10 to $60; pain management usually limited to 3 to 7 days of low-dose opioids or NSAIDs
- **Lymphedema prevention (axillary cases):** compression sleeves $40 to $150 per sleeve; PT evaluation for lymphedema risk $200 to $400
- **Time off work:** 3 to 14 days depending on job type and variant; budget unpaid days if no short-term disability

Plan on the full diagnostic episode costing 20% to 40% more than the biopsy alone once pathology, imaging, and follow-up visits are added in. If the biopsy leads to a cancer diagnosis, the real cost curve is just starting; ask your care team for a social worker or financial navigator referral before the first chemotherapy or surgical oncology appointment.

## Variants of this procedure

- Deep Axillary Lymph Node Biopsy
- Laparoscopic Pelvic Lymph Node Removal

## Frequently asked questions

### How much does a lymph node biopsy cost with insurance?

Most commercially insured patients pay $800 to $3,500 out of pocket for a standalone lymph node biopsy, depending on deductible, coinsurance, and setting. If the biopsy is done in an ambulatory surgery center instead of a hospital outpatient department, your share is typically 30% to 50% lower. Confirm in-network status for the surgeon, facility, anesthesia group, and pathologist before you schedule.

### Does Medicare cover a lymph node biopsy?

Yes. Medicare Part B covers medically necessary lymph node biopsies at 80% of the allowed amount after your annual Part B deductible ($257 in 2025 figure). You pay the remaining 20% coinsurance unless you have Medigap, Medicare Advantage, or Medicaid. The surgeon, facility, anesthesia, and pathology all bill separately under Part B for outpatient cases.

### How long is recovery after a lymph node biopsy?

A deep axillary biopsy usually has you back to desk work within 3 to 7 days, with lifting restrictions for about 2 to 3 weeks. A laparoscopic pelvic lymph node removal, which is almost always part of a larger cancer surgery, needs 2 to 4 weeks of recovery. Most patients have one or two post-op visits and a pathology-review visit in the first month.

### Is a lymph node biopsy outpatient or does it require a hospital stay?

Nearly all lymph node biopsies are outpatient, meaning you go home the same day. Medicare data shows about 97% are done in a facility setting that does not require admission. The exception is when the biopsy is bundled with a larger cancer surgery such as radical prostatectomy or hysterectomy, in which case the stay is driven by the main operation, not the node removal.

### What's the difference between an axillary and a pelvic lymph node biopsy?

An axillary biopsy (CPT 38525) removes deep nodes under the arm, typically to stage breast cancer or work up unexplained underarm swelling, through a single incision in about 30 to 90 minutes. A pelvic lymphadenectomy (CPT 38571) removes nodes on both sides of the pelvis using laparoscopic keyhole incisions, takes 1 to 2.5 hours, and is almost always done alongside prostate, bladder, or gynecologic cancer surgery.

### How do I avoid a surprise bill on a lymph node biopsy?

Ask upfront for the names of the anesthesia group and the pathology group that will handle your case, then call your insurer to confirm both are in-network. Request a Good Faith Estimate in writing. If you get a surprise bill from an out-of-network provider at an in-network facility, invoke the No Surprises Act at cms.gov/nosurprises before paying anything.

### What's the cheapest way to get a lymph node biopsy?

If you are medically stable, an ambulatory surgery center is typically 40% to 60% cheaper than a hospital outpatient department for the same procedure. For uninsured patients, ask for a bundled cash-pay price that includes surgeon, facility, anesthesia, and pathology. Many nonprofit hospitals also have charity-care policies covering patients under 200% to 400% of the federal poverty line.

### Where does this cost data come from?

The Medicare figures on this page come from the CMS Medicare Physician and Other Practitioners Public Use File. It reports average payments for HCPCS codes 38525 and 38571 across 2,049 facility providers and 44,314 services nationally. Commercial and cash-pay ranges are reasonable estimates based on typical commercial-to-Medicare payment ratios; actual prices vary by insurer, facility, and region.

## Related

- [All procedure cost concepts](https://ourhealthnetwork.com/procedure-costs)
- [Find specialists who perform this procedure](https://ourhealthnetwork.com/find-doctors)
- [Insurance plans that cover this procedure](https://ourhealthnetwork.com/tools/insurance-matcher)