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CPT code 38220: Marrow aspiration, diagnostic aspirate2026 Medicare rate & RVUs in Hawaii, Guam, HI

Reports needle aspiration of bone marrow for diagnostic evaluation, such as obtaining marrow material for hematologic testing or microscopic review.

CMS RVU26DEffective Oct 1, 2026One payment locality3.5K Medicare services in 2024

In Hawaii, Guam, HI, Medicare pays $183.61 for 38220 in the office and $56.01 when it’s performed in a hospital or facility.

$183.61Office (non-facility)
$56.01Hospital or facility
+9.5%vs the national office rate ($167.67)

Check a contract rate as a % of Medicare · 38220 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 38220 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Hawaii, Guam, HI
  2. What 38220 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 38220 covers

A clinician advances an aspiration needle into marrow, commonly at the posterior iliac crest, and withdraws liquid marrow for diagnostic studies. Hematologists and oncologists often perform the procedure in an office, clinic, or hospital setting; interventional radiologists may perform it with image guidance when clinically needed. The aspirate can support evaluation of suspected marrow disorders, cytopenias, or hematologic malignancy. This code describes aspiration, not removal of a core tissue specimen.

Select this service when diagnostic marrow is aspirated without a marrow biopsy during the encounter. When both aspiration and biopsy are performed, use 38222 rather than separately reporting 38220 and 38221. Documentation should identify the diagnostic purpose, procedure site, and aspiration performed. CMS applies the standard multiple-procedure reduction when applicable procedures are performed in the same session: the highest-valued procedure is paid in full and others at 50%. For a bilateral procedure reported with modifier 50, CMS pays at 150%.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Hawaii, Guam, HI compares for 38220

Across 109 of 109 payment localities, the office rate for 38220 runs from $148.51 in Arkansas to $226.09 in San Benito County, CA. Hawaii, Guam, HI pays $183.61. The RVUs are the same everywhere; the geographic indexes change the dollars.

38220 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$183.61
  2. Los Angeles, CA · California$191.25+$7.64
  3. Washington, DC area · District of Columbia$192.48+$8.87
  4. Miami, FL · Florida$177.42−$6.19
  5. Chicago, IL · Illinois$172.47−$11.14
  6. Manhattan, NY · New York$192.28+$8.67
  7. Alaska · Alaska$194.03+$10.42

Other areas in Hawaii first, then benchmark localities. Bars start at $0.

Every other payment area

38220 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$150.67$52.47
ArkansasArkansas$148.51$52.10
ArizonaArizona$163.35$54.60
Bakersfield, CACalifornia$179.30$56.30
Chico, CACalifornia$179.00$56.00
El Centro, CACalifornia$179.01$56.01
Fresno, CACalifornia$179.00$56.00
Hanford, CACalifornia$179.00$56.00

38220 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$148.51

$202.55

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
38220 office rate range by state
State / territoryOffice rate rangeLocalities
AK$194.031
AL$150.671
AR$148.511
AZ$163.351
CA$179.00–$226.0929
CO$175.521
CT$178.761
DC$192.481
DE$166.061
FL$163.66–$177.423
GA$154.69–$170.402
GU$183.611
HI$183.611
IA$155.181
ID$156.041
IL$158.44–$173.664
IN$156.961
KS$154.131
KY$153.481
LA$153.10–$160.672
MA$174.34–$193.312
MD$169.32–$192.483
ME$156.49–$165.432
MI$157.13–$165.342
MN$169.201
MO$150.26–$161.653
MS$149.431
MT$167.671
NC$158.171
ND$165.891
NE$156.131
NH$172.451
NJ$181.08–$190.432
NM$157.851
NV$167.301
NY$160.50–$196.495
OH$156.771
OK$153.561
OR$166.28–$181.472
PA$157.21–$174.112
PR$169.011
RI$172.231
SC$157.681
SD$165.681
TN$154.851
TX$156.16–$174.698
UT$159.831
VA$164.65–$192.482
VI$169.011
VT$164.931
WA$174.12–$197.582
WI$160.321
WV$152.521
WY$166.891

See 38220 in every payment locality

How the 38220 rate is calculated

Each of 38220’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 38220

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.17

1.17 RVUs× 1.000 GPCI

Practice expense3.76

3.76 RVUs× 1.000 GPCI

Malpractice0.09

0.09 RVUs× 1.000 GPCI

Adjusted RVUs

5.0200

Conversion factor

$33.4009

Medicare rate

$167.67

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Hawaii, Guam, HI inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,722

Code
38220
Physician work
1.17
Practice expense
3.76
Malpractice
0.09

GPCI2026.csv

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 38220 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work1.17× 1.0001.1700
Practice expense3.76× 1.1374.2751
Malpractice0.09× 0.5790.0521
Total RVUs5.4972
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$183.61

Office: (1.17 × 1 + 3.76 × 1.137 + 0.09 × 0.579) × $33.4009 = $183.61

Facility: (1.17 × 1 + 0.4 × 1.137 + 0.09 × 0.579) × $33.4009 = $56.01

Open 38220 in the RVU calculator

Payment rules and modifiers for 38220

The CMS indicators that decide how 38220 is paid alongside other services.

CMS payment indicators · 38220

Marrow aspiration, diagnostic aspirate

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

38220 without 50 · national office

$167.67

Marrow aspiration, diagnostic aspirate

38220-50 · Bilateral: 150%

$251.50

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 38220

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 38220
CodeHow it relatesOffice range, Hawaii, Guam, HI
Same family
38221Bone marrow biopsy, biopsy without aspirationDiagnostic marrow core biopsy, distinct from aspiration of liquid marrow.$182.11
Used instead
38222Bone marrow exam, aspiration and biopsyUse for diagnostic marrow aspiration and biopsy performed together.$192.45
Often billed with
85097Marrow interpretation, aspirate or biopsy reviewMay represent pathologist interpretation of a bone marrow smear from the aspirate.$71.95

How 38220 has changed in Hawaii, Guam, HI

38220 · Office / nonfacility

$183.61

Effective 2026-10-01

The base rate is $15.87 higher than on 2025-10-01, moving from $167.74 to $183.61 (9.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $167.74changed to$183.61

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.20 changed to 1.17
    • Practice expense RVU 3.42 changed to 3.76
    • Malpractice RVU 0.10 changed to 0.09
    • Practice expense GPCI 1.149 changed to 1.137
    • Malpractice GPCI 0.561 changed to 0.579

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $172.62changed to$167.74

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $169.80changed to$172.62

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $172.59changed to$169.80

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.34 changed to 3.42
    • Work GPCI 1.003 changed to 1.000
    • Practice expense GPCI 1.146 changed to 1.149
    • Malpractice GPCI 0.618 changed to 0.561

  5. January 1, 2023

    RVU23A

    $176.55changed to$172.59

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.35 changed to 3.34
    • Malpractice RVU 0.09 changed to 0.10
    • Work GPCI 1.010 changed to 1.003
    • Practice expense GPCI 1.143 changed to 1.146
    • Malpractice GPCI 0.675 changed to 0.618

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $188.68changed to$176.55

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.57 changed to 3.35
    • Malpractice RVU 0.17 changed to 0.09

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $187.71changed to$188.68

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.39 changed to 3.57
    • Malpractice RVU 0.18 changed to 0.17
    • Work GPCI 1.006 changed to 1.010
    • Practice expense GPCI 1.144 changed to 1.143
    • Malpractice GPCI 0.644 changed to 0.675

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $185.19changed to$187.71

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.35 changed to 3.39
    • Malpractice RVU 0.16 changed to 0.18
    • Work GPCI 1.001 changed to 1.006
    • Practice expense GPCI 1.146 changed to 1.144
    • Malpractice GPCI 0.614 changed to 0.644

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $189.97changed to$185.19

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.46 changed to 3.35
    • Malpractice RVU 0.18 changed to 0.16

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $188.76changed to$189.97

    • Conversion factor 35.8887 changed to 35.9996
    • Work RVU 1.08 changed to 1.20
    • Practice expense RVU 3.54 changed to 3.46
    • Malpractice RVU 0.15 changed to 0.18
    • Work GPCI 1.002 changed to 1.001
    • Practice expense GPCI 1.154 changed to 1.146
    • Malpractice GPCI 0.616 changed to 0.614

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $185.83changed to$188.76

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.46 changed to 3.54
    • Malpractice RVU 0.14 changed to 0.15
    • Work GPCI 1.003 changed to 1.002
    • Practice expense GPCI 1.162 changed to 1.154
    • Malpractice GPCI 0.618 changed to 0.616

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $186.09changed to$185.83

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.45 changed to 3.46

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $185.16changed to$186.09

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $179.50changed to$185.16

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.33 changed to 3.45
    • Malpractice RVU 0.11 changed to 0.14
    • Work GPCI 1.002 changed to 1.003
    • Practice expense GPCI 1.158 changed to 1.162
    • Malpractice GPCI 0.659 changed to 0.618

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $183.07changed to$179.50

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.66 changed to 3.33
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.700 changed to 0.659

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$183.07

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$183.61$56.01RVU26D
2026-07-01$183.61$56.01RVU26C
2026-04-01$183.61$56.01RVU26B
2026-01-01$183.61$56.01RVU26A
2025-10-01$167.74$67.02RVU25D
2025-07-01$167.74$67.02RVU25C
2025-04-01$167.74$67.02RVU25B
2025-01-01$167.74$67.02RVU25A
2024-10-01$172.62$68.20RVU24D
2024-07-01$172.62$68.20RVU24C
2024-04-01$172.62$68.20RVU24B
2024-03-09$172.62$68.20RVU24AR
2024-01-01$169.80$67.09RVU24A
2023-10-01$172.59$70.07RVU23D
2023-07-01$172.59$70.07RVU23C
2023-04-01$172.59$70.07RVU23B
2023-01-01$172.59$70.07RVU23A
2022-10-01$176.55$71.73RVU22D
2022-07-01$176.55$71.73RVU22C
2022-04-01$176.55$71.73RVU22B
2022-01-01$176.55$71.73RVU22A
2021-10-01$188.68$72.62RVU21D
2021-07-01$188.68$72.62RVU21C
2021-04-01$188.68$72.62RVU21B
2021-01-01$188.68$72.62RVU21A
2020-10-01$187.71$73.76RVU20D
2020-07-01$187.71$73.76RVU20C
2020-04-01$187.71$73.76RVU20B
2020-01-01$187.71$73.76RVU20A
2019-10-01$185.19$72.85RVU19D
2019-07-01$185.19$72.85RVU19C
2019-04-01$185.19$72.85RVU19B
2019-01-01$185.19$72.85RVU19A
2018-10-01$189.97$72.80RVU18D
2018-07-01$189.97$72.80RVU18C
2018-04-01$189.97$72.80RVU18B
2018-01-01$189.97$72.80RVU18AR1
2017-10-01$188.76$64.93RVU17D
2017-07-01$188.76$64.93RVU17C
2017-04-01$188.76$64.93RVU17B
2017-01-01$188.76$64.93RVU17A
2016-10-01$185.83$64.76RVU16D
2016-07-01$185.83$64.76RVU16C
2016-04-01$185.83$64.76RVU16B
2016-01-01$185.83$64.76RVU16A
2015-10-01$186.09$65.00RVU15D
2015-07-01$186.09$65.00RVU15C
2015-04-01$185.16$64.68RVU15B
2015-01-01$185.16$64.68RVU15A
2014-10-01$179.50$64.18RVU14D
2014-07-01$179.50$64.18RVU14C
2014-04-01$179.50$64.18RVU14B
2014-01-01$179.50$64.18RVU14A
2013-10-01$183.07$61.74RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 38220 for an earlier date of service

Where the Hawaii, Guam, HI rate applies

Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.

  • Ahuimanu
  • Aiea
  • Ainaloa
  • Anahola
  • Black Sands
  • Captain Cook
  • Discovery Harbour
  • East Honolulu

Browse all communities in Hawaii

38220 billing questions

How is 38220 different from 38221?

38220 represents aspiration of liquid marrow for diagnostic testing; 38221 represents obtaining a core biopsy specimen. Use 38222 when both aspiration and biopsy are performed.

Can 38220 and 38221 be reported together for the same encounter?

When both diagnostic aspiration and biopsy are performed, report 38222 rather than separately reporting 38220 and 38221.

Does 38220 include interpretation of the marrow specimen?

The procedure code represents obtaining the aspirate. A pathologist may separately report marrow smear interpretation, such as 85097, when that service is performed and documented.

How does CMS price bilateral aspiration?

CMS pays a bilateral procedure reported with modifier 50 at 150%. Document the bilateral procedure and report modifier 50 when appropriate.

What happens when other procedures are performed in the same session?

Under the standard multiple-procedure reduction, CMS pays the highest-valued procedure in full and the other applicable procedures at 50% when performed in the same session.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 38220PPRRVU2026_Oct_nonQPP.csv, line 4,722 (RVU26D)
Geographic factors for Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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