CPT code 38221: Bone marrow biopsy, biopsy without aspiration2026 Medicare rate & RVUs
Reports needle or trocar sampling of bone marrow for diagnostic evaluation when a core biopsy is performed without marrow aspiration.
Medicare pays $167.00 for 38221 nationally in the office and $57.78 in a hospital or facility. Local office rates run $148.08–$223.63.
Medicare rate · 38221
Bone marrow biopsy, biopsy without aspiration
- Work RVUs
- 1.25
- Total RVUs
- 5.00
- Global days
- XXX
National rate · 2026
$167.00
Office setting, before claim adjustments.
See every locality for 38221 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 38221 covers
A clinician obtains a core of marrow through a needle or trocar, most often from the posterior iliac crest, to evaluate suspected or known marrow disease. Hematologists and oncologists commonly perform the procedure in an office, clinic, or hospital setting, often using local anesthesia. Typical indications include unexplained cytopenias, suspected leukemia or lymphoma, plasma cell disorders, and assessment of marrow involvement. The specimen is sent for pathologic evaluation.
Report 38221 when a diagnostic core biopsy is performed without aspiration; when both biopsy and aspiration are performed, use 38222 instead. Documentation should identify the indication, biopsy site and side, and the procedure performed. For bilateral biopsies, CMS pays 150% when modifier 50 is reported. When this service and another procedure subject to the multiple-procedure rule are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
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.
Where 38221 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$148.08 to $223.63
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $150.21 | $54.64 |
| Alaska | $194.13 | $77.81 |
| Arizona | $162.71 | $56.87 |
| Arkansas | $148.08 | $54.26 |
| Atlanta, GA | $169.81 | $58.85 |
| Austin, TX | $173.72 | $58.16 |
| Bakersfield, CA | $178.03 | $58.33 |
| Baltimore area, MD | $177.42 | $60.22 |
| Beaumont, TX | $155.80 | $56.41 |
| Brazoria, TX | $165.44 | $57.20 |
| Chicago, IL | $172.66 | $62.90 |
| Chico, CA | $177.68 | $57.97 |
| Colorado | $174.48 | $58.27 |
| Connecticut | $177.97 | $60.34 |
| Dallas, TX | $166.37 | $57.59 |
| Delaware | $165.38 | $57.47 |
| Detroit, MI | $165.27 | $59.87 |
| East St. Louis, IL | $161.00 | $60.52 |
| El Centro, CA | $177.70 | $57.99 |
| Fort Lauderdale, FL | $171.55 | $60.91 |
| Fort Worth, TX | $165.20 | $57.51 |
| Fresno, CA | $177.68 | $57.97 |
| Galveston, TX | $165.86 | $57.40 |
| Hanford, CA | $177.68 | $57.97 |
| Hawaii, Guam, HI | $182.11 | $57.93 |
| Houston, TX | $167.87 | $59.41 |
| Idaho | $155.34 | $54.86 |
| Indiana | $156.24 | $54.99 |
| Iowa | $154.45 | $54.52 |
| Kansas | $153.51 | $54.77 |
| Kentucky | $153.20 | $56.10 |
| King County, WA | $196.02 | $62.00 |
| Los Angeles, CA | $189.73 | $60.52 |
| Madera, CA | $177.68 | $57.97 |
| Manhattan, NY | $191.53 | $64.61 |
| Marin County, CA | $218.83 | $64.83 |
| Merced, CA | $177.68 | $57.97 |
| Metropolitan Boston, MA | $191.90 | $61.49 |
| Metropolitan Kansas City, MO | $159.50 | $56.95 |
| Metropolitan Philadelphia, PA | $173.45 | $59.75 |
| Metropolitan St. Louis, MO | $161.18 | $57.20 |
| Miami, FL | $177.61 | $63.91 |
| Minnesota | $167.94 | $55.56 |
| Mississippi | $149.15 | $55.11 |
| Modesto, CA | $177.68 | $57.97 |
| Montana | $167.00 | $57.78 |
| Napa, CA | $206.49 | $62.54 |
| Nebraska | $155.36 | $54.55 |
| Nevada | $166.51 | $57.18 |
| New Hampshire | $171.53 | $57.83 |
| New Mexico | $157.65 | $57.50 |
| New Orleans, LA | $160.33 | $57.55 |
| North Carolina | $157.53 | $55.63 |
| North Dakota | $164.82 | $55.60 |
| Northern New Jersey | $189.34 | $62.64 |
| NYC suburbs and Long Island, NY | $195.80 | $65.94 |
| Ohio | $156.46 | $56.74 |
| Oklahoma | $153.18 | $55.64 |
| Oxnard, CA | $188.92 | $59.82 |
| Portland, OR | $180.23 | $58.88 |
| Poughkeepsie and northern NYC suburbs, NY | $181.20 | $61.61 |
| Puerto Rico | $168.29 | $57.86 |
| Queens, NY | $193.43 | $64.33 |
| Redding, CA | $177.68 | $57.97 |
| Rest of California | $177.68 | $57.97 |
| Rest of Florida | $163.50 | $59.09 |
| Rest of Georgia | $154.58 | $57.15 |
| Rest of Illinois | $158.50 | $58.78 |
| Rest of Louisiana | $152.87 | $56.21 |
| Rest of Maine | $155.89 | $55.41 |
| Rest of Maryland | $168.58 | $58.05 |
| Rest of Massachusetts | $173.37 | $58.36 |
| Rest of Michigan | $156.90 | $57.18 |
| Rest of Missouri | $150.13 | $55.98 |
| Rest of New Jersey | $180.22 | $60.95 |
| Rest of New York | $159.83 | $56.07 |
| Rest of Oregon | $165.43 | $56.64 |
| Rest of Pennsylvania | $156.83 | $56.57 |
| Rest of Texas | $160.45 | $56.80 |
| Rest of Washington | $173.11 | $58.10 |
| Rhode Island | $171.41 | $58.59 |
| Riverside, CA | $178.89 | $59.18 |
| Sacramento, CA | $186.62 | $59.60 |
| Salinas, CA | $185.93 | $59.34 |
| San Benito County, CA | $223.63 | $66.13 |
| San Diego, CA | $190.40 | $59.78 |
| San Francisco, CA | $218.71 | $64.70 |
| San Luis Obispo, CA | $182.91 | $58.51 |
| Santa Clara County, CA | $223.12 | $65.62 |
| Santa Cruz, CA | $192.32 | $59.61 |
| Santa Maria, CA | $186.65 | $59.30 |
| Santa Rosa, CA | $194.27 | $60.15 |
| South Carolina | $157.21 | $56.29 |
| South Dakota | $164.56 | $55.34 |
| Southern Maine, ME | $164.55 | $56.32 |
| Stockton, CA | $177.68 | $57.97 |
| Suburban Chicago, IL | $173.42 | $61.25 |
| Tennessee | $154.24 | $54.96 |
| Utah | $159.33 | $56.67 |
| Vallejo, CA | $206.31 | $62.36 |
| Vermont | $163.97 | $55.84 |
| Virgin Islands, VI | $168.29 | $57.86 |
| Virginia | $163.86 | $56.49 |
| Visalia, CA | $177.68 | $57.97 |
| Washington, DC area | $191.32 | $62.65 |
| West Virginia | $152.66 | $57.75 |
| Wisconsin | $159.36 | $54.72 |
| Wyoming | $166.05 | $56.83 |
| Yuba City, CA | $177.68 | $57.97 |
38221 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$148.08
$200.66
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $194.13 | 1 |
| AL | $150.21 | 1 |
| AR | $148.08 | 1 |
| AZ | $162.71 | 1 |
| CA | $177.68–$223.63 | 29 |
| CO | $174.48 | 1 |
| CT | $177.97 | 1 |
| DC | $191.32 | 1 |
| DE | $165.38 | 1 |
| FL | $163.50–$177.61 | 3 |
| GA | $154.58–$169.81 | 2 |
| GU | $182.11 | 1 |
| HI | $182.11 | 1 |
| IA | $154.45 | 1 |
| ID | $155.34 | 1 |
| IL | $158.50–$173.42 | 4 |
| IN | $156.24 | 1 |
| KS | $153.51 | 1 |
| KY | $153.20 | 1 |
| LA | $152.87–$160.33 | 2 |
| MA | $173.37–$191.90 | 2 |
| MD | $168.58–$191.32 | 3 |
| ME | $155.89–$164.55 | 2 |
| MI | $156.90–$165.27 | 2 |
| MN | $167.94 | 1 |
| MO | $150.13–$161.18 | 3 |
| MS | $149.15 | 1 |
| MT | $167.00 | 1 |
| NC | $157.53 | 1 |
| ND | $164.82 | 1 |
| NE | $155.36 | 1 |
| NH | $171.53 | 1 |
| NJ | $180.22–$189.34 | 2 |
| NM | $157.65 | 1 |
| NV | $166.51 | 1 |
| NY | $159.83–$195.80 | 5 |
| OH | $156.46 | 1 |
| OK | $153.18 | 1 |
| OR | $165.43–$180.23 | 2 |
| PA | $156.83–$173.45 | 2 |
| PR | $168.29 | 1 |
| RI | $171.41 | 1 |
| SC | $157.21 | 1 |
| SD | $164.56 | 1 |
| TN | $154.24 | 1 |
| TX | $155.80–$173.72 | 8 |
| UT | $159.33 | 1 |
| VA | $163.86–$191.32 | 2 |
| VI | $168.29 | 1 |
| VT | $163.97 | 1 |
| WA | $173.11–$196.02 | 2 |
| WI | $159.36 | 1 |
| WV | $152.66 | 1 |
| WY | $166.05 | 1 |
How the 38221 rate is calculated
Each of 38221’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 · 38221
RVUs × geographic indexes × conversion factor
Work1.25
1.25 RVUs× 1.000 GPCI
Practice expense3.64
3.64 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
5.0000
Conversion factor
$33.4009
Medicare rate
$167.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38221
The CMS indicators that decide how 38221 is paid alongside other services.
CMS payment indicators · 38221
Bone marrow biopsy, biopsy without aspiration
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
38221 without 50 · national office
$167.00
Bone marrow biopsy, biopsy without aspiration
38221-50 · Bilateral: 150%
$250.50
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).
38221 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38220Marrow aspirationDiagnostic aspirate
- 38220 reports diagnostic marrow aspiration alone. Choose 38221 when a core biopsy is performed without aspiration.
- 38222Bone marrow examAspiration and biopsy
- 38222 represents diagnostic marrow aspiration and core biopsy together. Use 38221 when the procedure is limited to the core biopsy.
- 38230Marrow harvestAllogeneic donor
- 38230 is for harvesting marrow for allogeneic transplantation, not for obtaining a diagnostic core specimen.
38221 billing questions
When should 38221 be chosen over 38222?
Use 38221 for a diagnostic marrow core biopsy without aspiration. When both a biopsy and aspiration are performed, report 38222.
Can marrow aspiration be reported separately with 38221?
When aspiration and biopsy are both performed, use 38222 rather than separately reporting 38220 with 38221.
How is a bilateral bone marrow biopsy reported?
Report modifier 50 for a bilateral procedure; CMS pays 150%. Document the biopsy at both sites.
What documentation supports 38221?
Document the diagnostic indication, the site and side sampled, and that a needle or trocar core biopsy was performed without aspiration.
How does the multiple-procedure reduction affect 38221?
When another procedure subject to the rule is performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
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
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