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CPT code 85097: Marrow interpretation, aspirate or biopsy review2026 Medicare rate & RVUs in Puerto Rico

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 Puerto Rico, Medicare pays $68.17 for 85097 in the office and $39.13 when it’s performed in a hospital or facility.

$68.17Office (non-facility)
$39.13Hospital or facility
+0.5%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $68.17. The RVUs are the same everywhere; the geographic indexes change the dollars.

85097 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$68.17
  2. Los Angeles, CA · California$74.98+$6.81
  3. Washington, DC area · District of Columbia$75.95+$7.78
  4. Miami, FL · Florida$71.81+$3.64
  5. Chicago, IL · Illinois$70.36+$2.19
  6. Manhattan, NY · New York$76.48+$8.31
  7. Alaska · Alaska$84.72+$16.55

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

Every other payment area

85097 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$62.65$37.52
ArkansasArkansas$62.00$37.33
ArizonaArizona$66.47$38.63
Bakersfield, CACalifornia$71.13$39.65
Chico, CACalifornia$70.95$39.47
El Centro, CACalifornia$70.96$39.48
Fresno, CACalifornia$70.95$39.47
Hanford, CACalifornia$70.95$39.47

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 85097 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.92× 1.0000.9200
Practice expense1.06× 1.0111.0717
Malpractice0.05× 0.9850.0493
Total RVUs2.0409
Conversion factor× 33.4009

Office rate, Puerto Rico$68.17

Office: (0.92 × 1 + 1.06 × 1.011 + 0.05 × 0.985) × $33.4009 = $68.17

Facility: (0.92 × 1 + 0.2 × 1.011 + 0.05 × 0.985) × $33.4009 = $39.13

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, Puerto Rico
Often billed with
38220Marrow aspiration, diagnostic aspirateMarrow aspiration collection may be reported with a separately documented interpretation.$169.01
38221Bone marrow biopsy, biopsy without aspirationMarrow biopsy collection may accompany a separately documented interpretation.$168.29
88305Tissue pathology exam, level IV specimenMay represent separate histopathologic examination of submitted marrow core tissue.$70.63
Used instead
38222Bone marrow exam, aspiration and biopsyCombined aspiration, biopsy, and smear interpretation; includes the interpretation represented by 85097.$178.34
85060Blood smear, physician interpretationPhysician interpretation of peripheral blood smear rather than bone marrow material.No office rate

How 85097 has changed in Puerto Rico

85097 · Office / nonfacility

$68.17

Effective 2026-10-01

The base rate is $0.66 higher than on 2025-10-01, moving from $67.51 to $68.17 (1.0%).

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

    $67.51changed to$68.17

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $69.46changed to$67.51

    • 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

    $68.33changed to$69.46

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $69.40changed to$68.33

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $69.13changed to$69.40

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $69.82changed to$69.13

    • 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
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $70.04changed to$69.82

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

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $71.72changed to$70.04

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.99 changed to 1.01
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $76.31changed to$71.72

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.12 changed to 0.99
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $93.99changed to$76.31

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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $83.43changed to$93.99

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.58 changed to 1.61
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $73.31changed to$83.43

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.55 changed to 1.58
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $72.70changed to$73.31

    • 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.

  14. July 1, 2015

    RVU15C

    $72.34changed to$72.70

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $69.36changed to$72.34

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $67.93changed to$69.36

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.54 changed to 1.42
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $67.93

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$68.17$39.13RVU26D
2026-07-01$68.17$39.13RVU26C
2026-04-01$68.17$39.13RVU26B
2026-01-01$68.17$39.13RVU26A
2025-10-01$67.51$45.36RVU25D
2025-07-01$67.51$45.36RVU25C
2025-04-01$67.51$45.36RVU25B
2025-01-01$67.51$45.36RVU25A
2024-10-01$69.46$47.00RVU24D
2024-07-01$69.46$47.00RVU24C
2024-04-01$69.46$47.00RVU24B
2024-03-09$69.46$47.00RVU24AR
2024-01-01$68.33$46.24RVU24A
2023-10-01$69.40$47.88RVU23D
2023-07-01$69.13$47.78RVU23C
2023-04-01$69.13$47.78RVU23B
2023-01-01$69.13$47.78RVU23A
2022-10-01$69.82$48.54RVU22D
2022-07-01$69.82$48.54RVU22C
2022-04-01$69.82$48.54RVU22B
2022-01-01$69.82$48.54RVU22A
2021-10-01$70.04$49.29RVU21D
2021-07-01$70.04$49.29RVU21C
2021-04-01$70.04$49.29RVU21B
2021-01-01$70.04$49.29RVU21A
2020-10-01$71.72$51.35RVU20D
2020-07-01$71.72$51.35RVU20C
2020-04-01$71.72$51.35RVU20B
2020-01-01$71.72$51.35RVU20A
2019-10-01$76.31$51.27RVU19D
2019-07-01$76.31$51.27RVU19C
2019-04-01$76.31$51.27RVU19B
2019-01-01$76.31$51.27RVU19A
2018-10-01$93.99$51.57RVU18D
2018-07-01$93.99$51.57RVU18C
2018-04-01$93.99$51.57RVU18B
2018-01-01$93.99$51.57RVU18AR1
2017-10-01$83.43$48.40RVU17D
2017-07-01$83.43$48.40RVU17C
2017-04-01$83.43$48.40RVU17B
2017-01-01$83.43$48.40RVU17A
2016-10-01$73.31$45.03RVU16D
2016-07-01$73.31$45.03RVU16C
2016-04-01$73.31$45.03RVU16B
2016-01-01$73.31$45.03RVU16A
2015-10-01$72.70$44.59RVU15D
2015-07-01$72.70$44.59RVU15C
2015-04-01$72.34$44.36RVU15B
2015-01-01$72.34$44.36RVU15A
2014-10-01$69.36$43.58RVU14D
2014-07-01$69.36$43.58RVU14C
2014-04-01$69.36$43.58RVU14B
2014-01-01$69.36$43.58RVU14A
2013-10-01$67.93$41.86RVU13D
2013-07-01$67.93$41.86RVU13C
2013-04-01$67.93$41.86RVU13B
2013-01-01$67.93$41.86RVU13AR

Price 85097 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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