CPT code 85097: Marrow interpretation, aspirate or biopsy review2026 Medicare rate & RVUs in Missouri
Reports a physician’s microscopic interpretation of bone marrow aspirate or biopsy material in the evaluation of hematologic disease.
Medicare pays $62.87–$66.11 for 85097 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
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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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.
Where 85097 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$62.87 to $66.11
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $65.61 | $38.63 |
| Metropolitan St. Louis, MO | $66.11 | $38.76 |
| Rest of Missouri | $62.87 | $38.11 |
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
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.
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.
85097 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38222Bone marrow examAspiration and biopsy
- Use 85097 for interpretation alone. Code 38222 represents the combined aspiration, biopsy, and smear interpretation service.
- 88305Tissue pathology examLevel IV specimen
- 88305 represents surgical pathology examination of tissue, such as a submitted marrow core; 85097 reports interpretation of marrow material.
- 85060Blood smearPhysician interpretation
- 85060 concerns a peripheral blood smear. Use 85097 when the material being interpreted is bone marrow.
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
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