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CPT code 38221: Bone marrow biopsy, biopsy without aspiration2026 Medicare rate & RVUs in Washington, DC area

Reports needle or trocar sampling of bone marrow for diagnostic evaluation when a core biopsy is performed without marrow aspiration.

CMS RVU26DEffective Oct 1, 2026One payment locality5.5K Medicare services in 2024

In Washington, DC area, Medicare pays $191.32 for 38221 in the office and $62.65 when it’s performed in a hospital or facility.

$191.32Office (non-facility)
$62.65Hospital or facility
+14.6%vs the national office rate ($167.00)

Check a contract rate as a % of Medicare · 38221 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 38221 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 38221 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 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.

How Washington, DC area compares for 38221

Across 109 of 109 payment localities, the office rate for 38221 runs from $148.08 in Arkansas to $223.63 in San Benito County, CA. Washington, DC area pays $191.32. The RVUs are the same everywhere; the geographic indexes change the dollars.

38221 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$191.32
  2. Los Angeles, CA · California$189.73−$1.59
  3. Miami, FL · Florida$177.61−$13.71
  4. Chicago, IL · Illinois$172.66−$18.66
  5. Manhattan, NY · New York$191.53+$0.21
  6. Alaska · Alaska$194.13+$2.81
  7. Alabama · Alabama$150.21−$41.11

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

38221 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$148.08$54.26
ArizonaArizona$162.71$56.87
Bakersfield, CACalifornia$178.03$58.33
Chico, CACalifornia$177.68$57.97
El Centro, CACalifornia$177.70$57.99
Fresno, CACalifornia$177.68$57.97
Hanford, CACalifornia$177.68$57.97
Madera, CACalifornia$177.68$57.97

38221 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.

$148.08

$200.66

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

View every state and territory as a table
38221 office rate range by state
State / territoryOffice rate rangeLocalities
AK$194.131
AL$150.211
AR$148.081
AZ$162.711
CA$177.68–$223.6329
CO$174.481
CT$177.971
DC$191.321
DE$165.381
FL$163.50–$177.613
GA$154.58–$169.812
GU$182.111
HI$182.111
IA$154.451
ID$155.341
IL$158.50–$173.424
IN$156.241
KS$153.511
KY$153.201
LA$152.87–$160.332
MA$173.37–$191.902
MD$168.58–$191.323
ME$155.89–$164.552
MI$156.90–$165.272
MN$167.941
MO$150.13–$161.183
MS$149.151
MT$167.001
NC$157.531
ND$164.821
NE$155.361
NH$171.531
NJ$180.22–$189.342
NM$157.651
NV$166.511
NY$159.83–$195.805
OH$156.461
OK$153.181
OR$165.43–$180.232
PA$156.83–$173.452
PR$168.291
RI$171.411
SC$157.211
SD$164.561
TN$154.241
TX$155.80–$173.728
UT$159.331
VA$163.86–$191.322
VI$168.291
VT$163.971
WA$173.11–$196.022
WI$159.361
WV$152.661
WY$166.051

See 38221 in every payment locality

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

Office or facility?

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.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,723

Code
38221
Physician work
1.25
Practice expense
3.64
Malpractice
0.11

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 38221 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.25× 1.0541.3175
Practice expense3.64× 1.1784.2879
Malpractice0.11× 1.1130.1224
Total RVUs5.7278
Conversion factor× 33.4009

Office rate, Washington, DC area$191.32

Office: (1.25 × 1.054 + 3.64 × 1.178 + 0.11 × 1.113) × $33.4009 = $191.32

Facility: (1.25 × 1.054 + 0.37 × 1.178 + 0.11 × 1.113) × $33.4009 = $62.65

Open 38221 in the RVU calculator

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

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

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).

When to use modifier 50

Codes related to 38221

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

Codes related to 38221
CodeHow it relatesOffice range, Washington, DC area
Used instead
38220Marrow aspiration, diagnostic aspirateUse for diagnostic bone marrow aspiration without a core biopsy.$192.48
38222Bone marrow exam, aspiration and biopsyUse when diagnostic marrow aspiration and core biopsy are both performed.$202.45
Often billed with
88305Tissue pathology exam, level IV specimenMay represent the separately reported pathologic examination of the marrow biopsy specimen.$79.56

How 38221 has changed in Washington, DC area

38221 · Office / nonfacility

$191.32

Effective 2026-10-01

The base rate is $11.14 higher than on 2025-10-01, moving from $180.18 to $191.32 (6.2%).

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

    $180.18changed to$191.32

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.28 changed to 1.25
    • Practice expense RVU 3.44 changed to 3.64
    • Malpractice RVU 0.10 changed to 0.11
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $187.80changed to$180.18

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.50 changed to 3.44

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $184.73changed to$187.80

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $191.49changed to$184.73

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.44 changed to 3.50
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $198.71changed to$191.49

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.46 changed to 3.44
    • Malpractice RVU 0.09 changed to 0.10
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $196.48changed to$198.71

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.37 changed to 3.46

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $189.21changed to$196.48

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.10 changed to 3.37
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $183.45changed to$189.21

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.02 changed to 3.10
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $181.94changed to$183.45

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.99 changed to 3.02

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $198.78changed to$181.94

    • Conversion factor 35.8887 changed to 35.9996
    • Work RVU 1.37 changed to 1.28
    • Practice expense RVU 3.31 changed to 2.99
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $198.05changed to$198.78

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.30 changed to 3.31
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $198.80changed to$198.05

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.29 changed to 3.30
    • Malpractice RVU 0.10 changed to 0.09

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $197.81changed to$198.80

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $194.07changed to$197.81

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.23 changed to 3.29
    • Malpractice RVU 0.08 changed to 0.10
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $193.81changed to$194.07

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.48 changed to 3.23
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $193.81

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$191.32$62.65RVU26D
2026-07-01$191.32$62.65RVU26C
2026-04-01$191.32$62.65RVU26B
2026-01-01$191.32$62.65RVU26A
2025-10-01$180.18$74.15RVU25D
2025-07-01$180.18$74.15RVU25C
2025-04-01$180.18$74.15RVU25B
2025-01-01$180.18$74.15RVU25A
2024-10-01$187.80$76.70RVU24D
2024-07-01$187.80$76.70RVU24C
2024-04-01$187.80$76.70RVU24B
2024-03-09$187.80$76.70RVU24AR
2024-01-01$184.73$75.45RVU24A
2023-10-01$191.49$78.36RVU23D
2023-07-01$191.49$78.36RVU23C
2023-04-01$191.49$78.36RVU23B
2023-01-01$191.49$78.36RVU23A
2022-10-01$198.71$80.66RVU22D
2022-07-01$198.71$80.66RVU22C
2022-04-01$198.71$80.66RVU22B
2022-01-01$198.71$80.66RVU22A
2021-10-01$196.48$79.60RVU21D
2021-07-01$196.48$79.60RVU21C
2021-04-01$196.48$79.60RVU21B
2021-01-01$196.48$79.60RVU21A
2020-10-01$189.21$80.37RVU20D
2020-07-01$189.21$80.37RVU20C
2020-04-01$189.21$80.37RVU20B
2020-01-01$189.21$80.37RVU20A
2019-10-01$183.45$79.66RVU19D
2019-07-01$183.45$79.66RVU19C
2019-04-01$183.45$79.66RVU19B
2019-01-01$183.45$79.66RVU19A
2018-10-01$181.94$80.44RVU18D
2018-07-01$181.94$80.44RVU18C
2018-04-01$181.94$80.44RVU18B
2018-01-01$181.94$80.44RVU18AR1
2017-10-01$198.78$85.47RVU17D
2017-07-01$198.78$85.47RVU17C
2017-04-01$198.78$85.47RVU17B
2017-01-01$198.78$85.47RVU17A
2016-10-01$198.05$85.45RVU16D
2016-07-01$198.05$85.45RVU16C
2016-04-01$198.05$85.45RVU16B
2016-01-01$198.05$85.45RVU16A
2015-10-01$198.80$86.22RVU15D
2015-07-01$198.80$86.22RVU15C
2015-04-01$197.81$85.79RVU15B
2015-01-01$197.81$85.79RVU15A
2014-10-01$194.07$85.13RVU14D
2014-07-01$194.07$85.13RVU14C
2014-04-01$194.07$85.13RVU14B
2014-01-01$194.07$85.13RVU14A
2013-10-01$193.81$81.32RVU13D
2013-07-01$193.81$81.32RVU13C
2013-04-01$193.81$81.32RVU13B
2013-01-01$193.81$81.32RVU13AR

Price 38221 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

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

Show the CMS file lines behind this rate
RVUs for 38221PPRRVU2026_Oct_nonQPP.csv, line 4,723 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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