CPT code 38222: Bone marrow exam, aspiration and biopsy2026 Medicare rate & RVUs
Reports diagnostic bone marrow aspiration and core biopsy performed in the same session, commonly to evaluate unexplained cytopenias, suspected marrow disease, or hematologic malignancy.
Medicare pays $177.02 for 38222 nationally in the office and $62.46 in a hospital or facility. Local office rates run $157.16–$235.81.
Medicare rate · 38222
Bone marrow exam, aspiration and biopsy
- Work RVUs
- 1.4
- Total RVUs
- 5.30
- Global days
- XXX
National rate · 2026
$177.02
Office setting, before claim adjustments.
See every locality for 38222 →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 38222 covers
This code covers obtaining a bone marrow aspirate and a core biopsy for diagnostic evaluation during the same session. Hematologists, oncologists, and other qualified clinicians commonly perform the sampling, often from the posterior iliac crest, in an office procedure room, hospital, or outpatient facility. The samples can help evaluate unexplained anemia or other cytopenias, suspected marrow disorders, and hematologic malignancies.
Report this code when both aspiration and biopsy are performed; use 38220 for aspiration alone and 38221 for biopsy alone. Document the indication, sampling site or sites, and performance of both techniques. 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 other procedures at 50%. For a bilateral procedure reported with modifier 50, CMS pays 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.
Where 38222 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
$157.16 to $235.81
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $159.40 | $59.16 |
| Alaska | $206.64 | $84.63 |
| Arizona | $172.50 | $61.48 |
| Arkansas | $157.16 | $58.75 |
| Atlanta, GA | $180.05 | $63.65 |
| Austin, TX | $183.93 | $62.72 |
| Bakersfield, CA | $188.30 | $62.74 |
| Baltimore area, MD | $187.99 | $65.07 |
| Beaumont, TX | $165.38 | $61.13 |
| Brazoria, TX | $175.31 | $61.78 |
| Chicago, IL | $183.60 | $68.47 |
| Chico, CA | $187.89 | $62.33 |
| Colorado | $184.69 | $62.80 |
| Connecticut | $188.57 | $65.18 |
| Dallas, TX | $176.33 | $62.22 |
| Delaware | $175.31 | $62.12 |
| Detroit, MI | $175.60 | $65.04 |
| East St. Louis, IL | $171.35 | $65.95 |
| El Centro, CA | $187.92 | $62.35 |
| Fort Lauderdale, FL | $182.17 | $66.12 |
| Fort Worth, TX | $175.12 | $62.16 |
| Fresno, CA | $187.89 | $62.33 |
| Galveston, TX | $175.77 | $62.01 |
| Hanford, CA | $187.89 | $62.33 |
| Hawaii, Guam, HI | $192.45 | $62.19 |
| Houston, TX | $178.15 | $64.39 |
| Idaho | $164.66 | $59.26 |
| Indiana | $165.60 | $59.40 |
| Iowa | $163.70 | $58.88 |
| Kansas | $162.78 | $59.22 |
| Kentucky | $162.68 | $60.83 |
| King County, WA | $207.15 | $66.58 |
| Los Angeles, CA | $200.53 | $65.00 |
| Madera, CA | $187.89 | $62.33 |
| Manhattan, NY | $202.96 | $69.84 |
| Marin County, CA | $230.75 | $69.21 |
| Merced, CA | $187.89 | $62.33 |
| Metropolitan Boston, MA | $202.89 | $66.10 |
| Metropolitan Kansas City, MO | $169.24 | $61.67 |
| Metropolitan Philadelphia, PA | $183.87 | $64.61 |
| Metropolitan St. Louis, MO | $170.99 | $61.92 |
| Miami, FL | $188.83 | $69.56 |
| Minnesota | $177.62 | $59.73 |
| Mississippi | $158.39 | $59.75 |
| Modesto, CA | $187.89 | $62.33 |
| Montana | $177.02 | $62.45 |
| Napa, CA | $217.88 | $66.88 |
| Nebraska | $164.63 | $58.88 |
| Nevada | $176.43 | $61.75 |
| New Hampshire | $181.64 | $62.38 |
| New Mexico | $167.45 | $62.39 |
| New Orleans, LA | $170.19 | $62.38 |
| North Carolina | $167.02 | $60.13 |
| North Dakota | $174.45 | $59.88 |
| Northern New Jersey | $200.41 | $67.52 |
| NYC suburbs and Long Island, NY | $207.54 | $71.32 |
| Ohio | $166.10 | $61.51 |
| Oklahoma | $162.58 | $60.28 |
| Oxnard, CA | $199.61 | $64.20 |
| Portland, OR | $190.64 | $63.36 |
| Poughkeepsie and northern NYC suburbs, NY | $192.00 | $66.55 |
| Puerto Rico | $178.34 | $62.52 |
| Queens, NY | $204.85 | $69.44 |
| Redding, CA | $187.89 | $62.33 |
| Rest of California | $187.89 | $62.33 |
| Rest of Florida | $173.67 | $64.14 |
| Rest of Georgia | $164.26 | $62.07 |
| Rest of Illinois | $168.51 | $63.92 |
| Rest of Louisiana | $162.36 | $60.97 |
| Rest of Maine | $165.31 | $59.91 |
| Rest of Maryland | $178.65 | $62.71 |
| Rest of Massachusetts | $183.57 | $62.93 |
| Rest of Michigan | $166.63 | $62.03 |
| Rest of Missouri | $159.53 | $60.78 |
| Rest of New Jersey | $190.90 | $65.80 |
| Rest of New York | $169.44 | $60.60 |
| Rest of Oregon | $175.23 | $61.12 |
| Rest of Pennsylvania | $166.46 | $61.29 |
| Rest of Texas | $170.18 | $61.46 |
| Rest of Washington | $183.27 | $62.63 |
| Rhode Island | $181.60 | $63.25 |
| Riverside, CA | $189.32 | $63.75 |
| Sacramento, CA | $197.22 | $63.98 |
| Salinas, CA | $196.48 | $63.70 |
| San Benito County, CA | $235.81 | $70.61 |
| San Diego, CA | $201.12 | $64.10 |
| San Francisco, CA | $230.60 | $69.06 |
| San Luis Obispo, CA | $193.31 | $62.82 |
| Santa Clara County, CA | $235.21 | $70.00 |
| Santa Cruz, CA | $203.07 | $63.87 |
| Santa Maria, CA | $197.22 | $63.64 |
| Santa Rosa, CA | $205.12 | $64.44 |
| South Carolina | $166.80 | $60.95 |
| South Dakota | $174.14 | $59.58 |
| Southern Maine, ME | $174.29 | $60.76 |
| Stockton, CA | $187.89 | $62.33 |
| Suburban Chicago, IL | $184.10 | $66.45 |
| Tennessee | $163.56 | $59.42 |
| Utah | $169.03 | $61.34 |
| Vallejo, CA | $217.66 | $66.67 |
| Vermont | $173.62 | $60.20 |
| Virgin Islands, VI | $178.34 | $62.52 |
| Virginia | $173.61 | $60.99 |
| Visalia, CA | $187.89 | $62.33 |
| Washington, DC area | $202.45 | $67.50 |
| West Virginia | $162.40 | $62.84 |
| Wisconsin | $168.73 | $58.98 |
| Wyoming | $175.90 | $61.33 |
| Yuba City, CA | $187.89 | $62.33 |
38222 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.
$157.16
$211.85
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 | $206.64 | 1 |
| AL | $159.40 | 1 |
| AR | $157.16 | 1 |
| AZ | $172.50 | 1 |
| CA | $187.89–$235.81 | 29 |
| CO | $184.69 | 1 |
| CT | $188.57 | 1 |
| DC | $202.45 | 1 |
| DE | $175.31 | 1 |
| FL | $173.67–$188.83 | 3 |
| GA | $164.26–$180.05 | 2 |
| GU | $192.45 | 1 |
| HI | $192.45 | 1 |
| IA | $163.70 | 1 |
| ID | $164.66 | 1 |
| IL | $168.51–$184.10 | 4 |
| IN | $165.60 | 1 |
| KS | $162.78 | 1 |
| KY | $162.68 | 1 |
| LA | $162.36–$170.19 | 2 |
| MA | $183.57–$202.89 | 2 |
| MD | $178.65–$202.45 | 3 |
| ME | $165.31–$174.29 | 2 |
| MI | $166.63–$175.60 | 2 |
| MN | $177.62 | 1 |
| MO | $159.53–$170.99 | 3 |
| MS | $158.39 | 1 |
| MT | $177.02 | 1 |
| NC | $167.02 | 1 |
| ND | $174.45 | 1 |
| NE | $164.63 | 1 |
| NH | $181.64 | 1 |
| NJ | $190.90–$200.41 | 2 |
| NM | $167.45 | 1 |
| NV | $176.43 | 1 |
| NY | $169.44–$207.54 | 5 |
| OH | $166.10 | 1 |
| OK | $162.58 | 1 |
| OR | $175.23–$190.64 | 2 |
| PA | $166.46–$183.87 | 2 |
| PR | $178.34 | 1 |
| RI | $181.60 | 1 |
| SC | $166.80 | 1 |
| SD | $174.14 | 1 |
| TN | $163.56 | 1 |
| TX | $165.38–$183.93 | 8 |
| UT | $169.03 | 1 |
| VA | $173.61–$202.45 | 2 |
| VI | $178.34 | 1 |
| VT | $173.62 | 1 |
| WA | $183.27–$207.15 | 2 |
| WI | $168.73 | 1 |
| WV | $162.40 | 1 |
| WY | $175.90 | 1 |
How the 38222 rate is calculated
Each of 38222’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 · 38222
RVUs × geographic indexes × conversion factor
Work1.40
1.40 RVUs× 1.000 GPCI
Practice expense3.77
3.77 RVUs× 1.000 GPCI
Malpractice0.13
0.13 RVUs× 1.000 GPCI
Adjusted RVUs
5.3000
Conversion factor
$33.4009
Medicare rate
$177.02
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38222
The CMS indicators that decide how 38222 is paid alongside other services.
CMS payment indicators · 38222
Bone marrow exam, aspiration and biopsy
| 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
38222 without 50 · national office
$177.02
Bone marrow exam, aspiration and biopsy
38222-50 · Bilateral: 150%
$265.53
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).
38222 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38220Marrow aspirationDiagnostic aspirate
- 38220 is for diagnostic marrow aspiration alone. Choose 38222 when a core biopsy is also obtained in the same session.
- 38221Bone marrow biopsyBiopsy without aspiration
- 38221 is for diagnostic marrow biopsy alone. Choose 38222 when aspiration is performed along with the biopsy.
- 38230Marrow harvestAllogeneic donor
- 38230 describes bone marrow harvest for allogeneic transplantation, not diagnostic sampling for evaluation of marrow disease.
38222 billing questions
When should 38222 be chosen over 38220 or 38221?
Use 38222 when diagnostic aspiration and core biopsy are both performed in the same session. Use 38220 for aspiration alone or 38221 for biopsy alone.
Can 38220 and 38221 also be reported with 38222?
Do not separately report the aspiration-only or biopsy-only code for the same sampling already represented by 38222.
How is bilateral sampling reported?
When the service is performed bilaterally, report modifier 50. CMS pays a bilateral procedure reported with modifier 50 at 150%.
What documentation supports reporting 38222?
Document the diagnostic reason, the sampling site or sites, and that both aspiration and core biopsy were performed.
Are marrow specimen interpretation services included in 38222?
38222 represents the sampling procedure. Bone marrow smear interpretation or surgical pathology examination may be separately represented by codes such as 85097 or 88305 when those services are performed and documented.
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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