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CPT code 85097: Marrow interpretation, aspirate or biopsy review2026 Medicare rate & RVUs in Los Angeles, CA

Reports a physician’s microscopic interpretation of bone marrow aspirate or biopsy material in the evaluation of hematologic disease.

CMS RVU26DEffective Oct 1, 2026One payment locality133.3K Medicare services in 2024

In Los Angeles, CA, Medicare pays $74.98 for 85097 in the office and $41.00 when it’s performed in a hospital or facility.

$74.98Office (non-facility)
$41.00Hospital or facility
+10.6%vs the national office rate ($67.80)

Check a contract rate as a % of Medicare · 85097 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 85097 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Los Angeles, CA
  2. What 85097 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 85097 covers

A physician, commonly a pathologist or hematopathologist, examines bone marrow material and documents findings that help diagnose or classify conditions such as leukemia, myelodysplastic syndromes, plasma cell disorders, and unexplained cytopenias. The material may include aspirate smears or a marrow biopsy. The interpretation is a diagnostic service, not the collection of the specimen.

Report 85097 for the physician’s marrow interpretation when that service is separately performed and documented. The record should identify the material reviewed, the clinical question, and the physician’s interpretive findings in a signed report. If aspiration, biopsy, and smear interpretation are reported together under 38222, the interpretation is included in that combined service; do not separately report 85097 for the same interpretation. A separately examined core biopsy may also have a surgical pathology service reported when supported by the work performed.

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 Los Angeles, CA compares for 85097

Across 109 of 109 payment localities, the office rate for 85097 runs from $62.00 in Arkansas to $86.06 in San Benito County, CA. Los Angeles, CA pays $74.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

85097 in Los Angeles, CA vs other payment areas
  1. Los Angeles, CA · this page$74.98
  2. Bakersfield, CA · California$71.13−$3.85
  3. Chico, CA · California$70.95−$4.03
  4. El Centro, CA · California$70.96−$4.02
  5. Fresno, CA · California$70.95−$4.03
  6. Hanford, CA · California$70.95−$4.03
  7. Madera, CA · California$70.95−$4.03

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

Every other payment area

85097 in every other Medicare payment locality
Payment localityOfficeFacility
Merced, CACalifornia$70.95$39.47
Modesto, CACalifornia$70.95$39.47
Napa, CACalifornia$80.18$42.32
Oxnard, CACalifornia$74.48$40.53
Redding, CACalifornia$70.95$39.47
Rest of CaliforniaCalifornia$70.95$39.47
Riverside, CACalifornia$71.51$40.03
Sacramento, CACalifornia$73.91$40.50

85097 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.

$62.00

$84.72

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

View every state and territory as a table
85097 office rate range by state
State / territoryOffice rate rangeLocalities
AK$84.721
AL$62.651
AR$62.001
AZ$66.471
CA$70.95–$86.0629
CO$70.071
CT$71.501
DC$75.951
DE$67.361
FL$67.09–$71.813
GA$64.30–$68.802
GU$71.951
HI$71.951
IA$63.791
ID$64.091
IL$65.66–$70.364
IN$64.361
KS$63.581
KY$63.731
LA$63.66–$65.942
MA$69.83–$75.752
MD$68.40–$75.953
ME$64.34–$66.872
MI$64.94–$67.712
MN$67.651
MO$62.87–$66.113
MS$62.451
MT$67.801
NC$64.831
ND$66.811
NE$64.041
NH$69.051
NJ$72.45–$75.522
NM$65.201
NV$67.561
NY$65.54–$77.895
OH$64.741
OK$63.641
OR$67.17–$71.802
PA$64.81–$70.132
PR$68.171
RI$69.381
SC$64.861
SD$66.691
TN$63.811
TX$64.50–$69.738
UT$65.511
VA$66.71–$75.952
VI$68.171
VT$66.621
WA$69.68–$77.072
WI$65.161
WV$63.891
WY$67.371

See 85097 in every payment locality

How the 85097 rate is calculated

Each of 85097’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 · 85097

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.92

0.92 RVUs× 1.000 GPCI

Practice expense1.06

1.06 RVUs× 1.000 GPCI

Malpractice0.05

0.05 RVUs× 1.000 GPCI

Adjusted RVUs

2.0300

Conversion factor

$33.4009

Medicare rate

$67.80

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

The exact Los Angeles, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

10,495

Code
85097
Physician work
0.92
Practice expense
1.06
Malpractice
0.05

GPCI2026.csv

13

Locality
Los Angeles, CA
Physician work
1.041
Practice expense
1.183
Malpractice
0.664
Office calculation for 85097 in Los Angeles, CA
ComponentRVULocality factorAdjusted
Physician work0.92× 1.0410.9577
Practice expense1.06× 1.1831.2540
Malpractice0.05× 0.6640.0332
Total RVUs2.2449
Conversion factor× 33.4009

Office rate, Los Angeles, CA$74.98

Office: (0.92 × 1.041 + 1.06 × 1.183 + 0.05 × 0.664) × $33.4009 = $74.98

Facility: (0.92 × 1.041 + 0.2 × 1.183 + 0.05 × 0.664) × $33.4009 = $41.00

Open 85097 in the RVU calculator

Payment rules and modifiers for 85097

85097 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · 85097

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$67.80

Non-facility (office)
$67.80
Facility
$39.08

Higher because the practice carries its own overhead.

Codes related to 85097

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

Codes related to 85097
CodeHow it relatesOffice range, Los Angeles, CA
Often billed with
38220Marrow aspiration, diagnostic aspirateMarrow aspiration collection may be reported with a separately documented interpretation.$191.25
38221Bone marrow biopsy, biopsy without aspirationMarrow biopsy collection may accompany a separately documented interpretation.$189.73
88305Tissue pathology exam, level IV specimenMay represent separate histopathologic examination of submitted marrow core tissue.$79.17
Used instead
38222Bone marrow exam, aspiration and biopsyCombined aspiration, biopsy, and smear interpretation; includes the interpretation represented by 85097.$200.53
85060Blood smear, physician interpretationPhysician interpretation of peripheral blood smear rather than bone marrow material.No office rate

How 85097 has changed in Los Angeles, CA

85097 · Office / nonfacility

$74.98

Effective 2026-10-01

The base rate is $0.08 lower than on 2025-10-01, moving from $75.06 to $74.98 (0.1%).

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

    $75.06changed to$74.98

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.94 changed to 0.92
    • Practice expense RVU 1.10 changed to 1.06
    • Malpractice RVU 0.04 changed to 0.05
    • Work GPCI 1.042 changed to 1.041
    • Practice expense GPCI 1.194 changed to 1.183
    • Malpractice GPCI 0.690 changed to 0.664

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $77.08changed to$75.06

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.09 changed to 1.10
    • Malpractice RVU 0.05 changed to 0.04

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $75.82changed to$77.08

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $76.83changed to$75.82

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.06 changed to 1.09
    • Malpractice RVU 0.04 changed to 0.05
    • Work GPCI 1.045 changed to 1.042
    • Practice expense GPCI 1.185 changed to 1.194
    • Malpractice GPCI 0.724 changed to 0.690

  5. January 1, 2023

    RVU23A

    $76.88changed to$76.83

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.02 changed to 1.06
    • Malpractice RVU 0.05 changed to 0.04
    • Work GPCI 1.048 changed to 1.045
    • Practice expense GPCI 1.175 changed to 1.185
    • Malpractice GPCI 0.757 changed to 0.724

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $77.10changed to$76.88

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.01 changed to 1.02

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $78.84changed to$77.10

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.99 changed to 1.01
    • Work GPCI 1.047 changed to 1.048
    • Practice expense GPCI 1.176 changed to 1.175
    • Malpractice GPCI 0.725 changed to 0.757

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $84.19changed to$78.84

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.12 changed to 0.99
    • Work GPCI 1.046 changed to 1.047
    • Practice expense GPCI 1.177 changed to 1.176
    • Malpractice GPCI 0.694 changed to 0.725

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $104.86changed to$84.19

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.61 changed to 1.12

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $103.05changed to$104.86

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.58 changed to 1.61
    • Work GPCI 1.047 changed to 1.046
    • Practice expense GPCI 1.169 changed to 1.177
    • Malpractice GPCI 0.801 changed to 0.694

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $101.30changed to$103.05

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.55 changed to 1.58
    • Practice expense GPCI 1.161 changed to 1.169
    • Malpractice GPCI 0.908 changed to 0.801

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $100.08changed to$101.30

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.52 changed to 1.55
    • Malpractice RVU 0.04 changed to 0.05

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $99.58changed to$100.08

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $95.38changed to$99.58

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.42 changed to 1.52
    • Malpractice RVU 0.05 changed to 0.04
    • Work GPCI 1.042 changed to 1.047
    • Practice expense GPCI 1.158 changed to 1.161
    • Malpractice GPCI 0.775 changed to 0.908

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $94.69changed to$95.38

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.54 changed to 1.42
    • Work GPCI 1.036 changed to 1.042
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.642 changed to 0.775

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$94.69

  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$74.98$41.00RVU26D
2026-07-01$74.98$41.00RVU26C
2026-04-01$74.98$41.00RVU26B
2026-01-01$74.98$41.00RVU26A
2025-10-01$75.06$48.80RVU25D
2025-07-01$75.06$48.80RVU25C
2025-04-01$75.06$48.80RVU25B
2025-01-01$75.06$48.80RVU25A
2024-10-01$77.08$50.45RVU24D
2024-07-01$77.08$50.45RVU24C
2024-04-01$77.08$50.45RVU24B
2024-03-09$77.08$50.45RVU24AR
2024-01-01$75.82$49.62RVU24A
2023-10-01$76.83$51.54RVU23D
2023-07-01$76.83$51.54RVU23C
2023-04-01$76.83$51.54RVU23B
2023-01-01$76.83$51.54RVU23A
2022-10-01$76.88$52.07RVU22D
2022-07-01$76.88$52.07RVU22C
2022-04-01$76.88$52.07RVU22B
2022-01-01$76.88$52.07RVU22A
2021-10-01$77.10$52.91RVU21D
2021-07-01$77.10$52.91RVU21C
2021-04-01$77.10$52.91RVU21B
2021-01-01$77.10$52.91RVU21A
2020-10-01$78.84$55.08RVU20D
2020-07-01$78.84$55.08RVU20C
2020-04-01$78.84$55.08RVU20B
2020-01-01$78.84$55.08RVU20A
2019-10-01$84.19$54.93RVU19D
2019-07-01$84.19$54.93RVU19C
2019-04-01$84.19$54.93RVU19B
2019-01-01$84.19$54.93RVU19A
2018-10-01$104.86$55.29RVU18D
2018-07-01$104.86$55.29RVU18C
2018-04-01$104.86$55.29RVU18B
2018-01-01$104.86$55.29RVU18AR1
2017-10-01$103.05$55.22RVU17D
2017-07-01$103.05$55.22RVU17C
2017-04-01$103.05$55.22RVU17B
2017-01-01$103.05$55.22RVU17A
2016-10-01$101.30$54.74RVU16D
2016-07-01$101.30$54.74RVU16C
2016-04-01$101.30$54.74RVU16B
2016-01-01$101.30$54.74RVU16A
2015-10-01$100.08$53.77RVU15D
2015-07-01$100.08$53.77RVU15C
2015-04-01$99.58$53.51RVU15B
2015-01-01$99.58$53.51RVU15A
2014-10-01$95.38$52.24RVU14D
2014-07-01$95.38$52.24RVU14C
2014-04-01$95.38$52.24RVU14B
2014-01-01$95.38$52.24RVU14A
2013-10-01$94.69$50.32RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 85097 for an earlier date of service

Where the Los Angeles, CA rate applies

Los Angeles, CA is a Medicare payment area, not a city. Our Census mapping connects it to 189 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Anaheim
  • Long Beach
  • Los Angeles
  • Orange
  • Acton
  • Agoura Hills
  • Agua Dulce
  • Alhambra

Browse all communities in California

85097 billing questions

Is 85097 used to collect the marrow specimen?

No. It reports the physician’s interpretation of marrow material; aspiration and biopsy collection are represented by separate procedure services.

How does 85097 differ from 38222?

85097 reports interpretation alone. Code 38222 represents combined marrow aspiration and biopsy with smear interpretation, so the same interpretation should not be separately reported as 85097.

Can 85097 be reported with a marrow biopsy pathology service?

It may be reported with a separate surgical pathology examination when the core biopsy tissue is separately examined and the documentation supports both services.

What documentation supports 85097?

Keep the marrow material reviewed, the diagnostic reason for the study, and a signed report of the physician’s microscopic interpretation.

Should 85097 be used for a peripheral blood smear?

No. 85097 concerns bone marrow material; 85060 is the related interpretation service for a peripheral blood smear.

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 85097PPRRVU2026_Oct_nonQPP.csv, line 10,495 (RVU26D)
Geographic factors for Los Angeles, CAGPCI2026.csv, line 13 (RVU26D)

Open CMS sourceHow we calculate rates

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