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CPT code 38221: Bone marrow biopsy, biopsy without aspiration2026 Medicare rate & RVUs in Virginia

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 Virginia, Medicare pays $163.86 for 38221 in the office and $56.49 when it’s performed in a hospital or facility.

$163.86Office (non-facility)
$56.49Hospital or facility
−1.9%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 Virginia
  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 Virginia 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. Virginia pays $163.86. The RVUs are the same everywhere; the geographic indexes change the dollars.

38221 in Virginia vs other payment areas
  1. Virginia · this page$163.86
  2. Los Angeles, CA · California$189.73+$25.87
  3. Washington, DC area · District of Columbia$191.32+$27.46
  4. Miami, FL · Florida$177.61+$13.75
  5. Chicago, IL · Illinois$172.66+$8.80
  6. Manhattan, NY · New York$191.53+$27.67
  7. Alaska · Alaska$194.13+$30.27

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

Every other payment area

38221 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$150.21$54.64
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

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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 38221 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.25× 1.0001.2500
Practice expense3.64× 0.9833.5781
Malpractice0.11× 0.7060.0777
Total RVUs4.9058
Conversion factor× 33.4009

Office rate, Virginia$163.86

Office: (1.25 × 1 + 3.64 × 0.983 + 0.11 × 0.706) × $33.4009 = $163.86

Facility: (1.25 × 1 + 0.37 × 0.983 + 0.11 × 0.706) × $33.4009 = $56.49

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, Virginia
Used instead
38220Marrow aspiration, diagnostic aspirateUse for diagnostic bone marrow aspiration without a core biopsy.$164.65
38222Bone marrow exam, aspiration and biopsyUse when diagnostic marrow aspiration and core biopsy are both performed.$173.61
Often billed with
88305Tissue pathology exam, level IV specimenMay represent the separately reported pathologic examination of the marrow biopsy specimen.$69.18

How 38221 has changed in Virginia

38221 · Office / nonfacility

$163.86

Effective 2026-10-01

The base rate is $10.44 higher than on 2025-10-01, moving from $153.42 to $163.86 (6.8%).

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

    $153.42changed to$163.86

    • 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 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $159.85changed to$153.42

    • 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

    $157.24changed to$159.85

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $161.58changed to$157.24

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.44 changed to 3.50
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $166.23changed to$161.58

    • 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
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $164.48changed to$166.23

    • 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

    $160.00changed to$164.48

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.10 changed to 3.37
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $156.39changed to$160.00

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.02 changed to 3.10
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $155.15changed to$156.39

    • 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

    $168.97changed to$155.15

    • 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
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $167.85changed to$168.97

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.30 changed to 3.31
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $168.40changed to$167.85

    • 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

    $167.56changed to$168.40

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $164.70changed to$167.56

    • 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
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $164.28changed to$164.70

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.48 changed to 3.23
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $164.28

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$163.86$56.49RVU26D
2026-07-01$163.86$56.49RVU26C
2026-04-01$163.86$56.49RVU26B
2026-01-01$163.86$56.49RVU26A
2025-10-01$153.42$65.89RVU25D
2025-07-01$153.42$65.89RVU25C
2025-04-01$153.42$65.89RVU25B
2025-01-01$153.42$65.89RVU25A
2024-10-01$159.85$68.13RVU24D
2024-07-01$159.85$68.13RVU24C
2024-04-01$159.85$68.13RVU24B
2024-03-09$159.85$68.13RVU24AR
2024-01-01$157.24$67.02RVU24A
2023-10-01$161.58$69.32RVU23D
2023-07-01$161.58$69.32RVU23C
2023-04-01$161.58$69.32RVU23B
2023-01-01$161.58$69.32RVU23A
2022-10-01$166.23$71.19RVU22D
2022-07-01$166.23$71.19RVU22C
2022-04-01$166.23$71.19RVU22B
2022-01-01$166.23$71.19RVU22A
2021-10-01$164.48$70.39RVU21D
2021-07-01$164.48$70.39RVU21C
2021-04-01$164.48$70.39RVU21B
2021-01-01$164.48$70.39RVU21A
2020-10-01$160.00$71.66RVU20D
2020-07-01$160.00$71.66RVU20C
2020-04-01$160.00$71.66RVU20B
2020-01-01$160.00$71.66RVU20A
2019-10-01$156.39$71.46RVU19D
2019-07-01$156.39$71.46RVU19C
2019-04-01$156.39$71.46RVU19B
2019-01-01$156.39$71.46RVU19A
2018-10-01$155.15$72.09RVU18D
2018-07-01$155.15$72.09RVU18C
2018-04-01$155.15$72.09RVU18B
2018-01-01$155.15$72.09RVU18AR1
2017-10-01$168.97$76.36RVU17D
2017-07-01$168.97$76.36RVU17C
2017-04-01$168.97$76.36RVU17B
2017-01-01$168.97$76.36RVU17A
2016-10-01$167.85$75.99RVU16D
2016-07-01$167.85$75.99RVU16C
2016-04-01$167.85$75.99RVU16B
2016-01-01$167.85$75.99RVU16A
2015-10-01$168.40$76.56RVU15D
2015-07-01$168.40$76.56RVU15C
2015-04-01$167.56$76.18RVU15B
2015-01-01$167.56$76.18RVU15A
2014-10-01$164.70$75.88RVU14D
2014-07-01$164.70$75.88RVU14C
2014-04-01$164.70$75.88RVU14B
2014-01-01$164.70$75.88RVU14A
2013-10-01$164.28$72.53RVU13D
2013-07-01$164.28$72.53RVU13C
2013-04-01$164.28$72.53RVU13B
2013-01-01$164.28$72.53RVU13AR

Price 38221 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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