CPT code 85097: Marrow interpretation, aspirate or biopsy review2026 Medicare rate & RVUs in South Dakota
Reports a physician’s microscopic interpretation of bone marrow aspirate or biopsy material in the evaluation of hematologic disease.
In South Dakota, Medicare pays $66.69 for 85097 in the office and $37.97 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 South Dakota 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. South Dakota pays $66.69. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$66.69
- Los Angeles, CA · California$74.98+$8.29
- Washington, DC area · District of Columbia$75.95+$9.26
- Miami, FL · Florida$71.81+$5.12
- Chicago, IL · Illinois$70.36+$3.67
- Manhattan, NY · New York$76.48+$9.79
- Alaska · Alaska$84.72+$18.03
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $70.95 | $39.47 |
| 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 |
| Salinas, CACalifornia | $73.61 | $40.32 |
| San Diego, CACalifornia | $74.90 | $40.55 |
| Marin County, CACalifornia | $84.34 | $43.83 |
| San Francisco, CACalifornia | $84.28 | $43.78 |
| San Benito County, CACalifornia | $86.06 | $44.64 |
| Santa Clara County, CACalifornia | $85.83 | $44.40 |
| San Luis Obispo, CACalifornia | $72.47 | $39.76 |
| Santa Cruz, CACalifornia | $75.29 | $40.39 |
| Santa Maria, CACalifornia | $73.77 | $40.27 |
| Santa Rosa, CACalifornia | $76.02 | $40.75 |
| Stockton, CACalifornia | $70.95 | $39.47 |
| Vallejo, CACalifornia | $80.10 | $42.24 |
| Visalia, CACalifornia | $70.95 | $39.47 |
| Yuba City, CACalifornia | $70.95 | $39.47 |
| ColoradoColorado | $70.07 | $39.51 |
| ConnecticutConnecticut | $71.50 | $40.56 |
| DelawareDelaware | $67.36 | $38.98 |
| Fort Lauderdale, FLFlorida | $69.61 | $40.52 |
| Rest of FloridaFlorida | $67.09 | $39.63 |
| Atlanta, GAGeorgia | $68.80 | $39.61 |
| Rest of GeorgiaGeorgia | $64.30 | $38.68 |
| Hawaii, Guam, HIHawaii | $71.95 | $39.29 |
| IowaIowa | $63.79 | $37.50 |
| IdahoIdaho | $64.09 | $37.66 |
| East St. Louis, ILIllinois | $66.66 | $40.24 |
| Rest of IllinoisIllinois | $65.66 | $39.44 |
| Suburban Chicago, ILIllinois | $70.26 | $40.76 |
| IndianaIndiana | $64.36 | $37.73 |
| KansasKansas | $63.58 | $37.61 |
| KentuckyKentucky | $63.73 | $38.20 |
| New Orleans, LALouisiana | $65.94 | $38.91 |
| Rest of LouisianaLouisiana | $63.66 | $38.24 |
| Metropolitan Boston, MAMassachusetts | $75.75 | $41.45 |
| Rest of MassachusettsMassachusetts | $69.83 | $39.59 |
| Baltimore area, MDMaryland | $71.28 | $40.45 |
| Rest of MarylandMaryland | $68.40 | $39.33 |
| Rest of MaineMaine | $64.34 | $37.91 |
| Southern Maine, MEMaine | $66.87 | $38.40 |
| Detroit, MIMichigan | $67.71 | $39.99 |
| Rest of MichiganMichigan | $64.94 | $38.71 |
| MinnesotaMinnesota | $67.65 | $38.10 |
| Metropolitan Kansas City, MOMissouri | $65.61 | $38.63 |
| Metropolitan St. Louis, MOMissouri | $66.11 | $38.76 |
| Rest of MissouriMissouri | $62.87 | $38.11 |
| MississippiMississippi | $62.45 | $37.71 |
| MontanaMontana | $67.80 | $39.08 |
| North CarolinaNorth Carolina | $64.83 | $38.03 |
| North DakotaNorth Dakota | $66.81 | $38.09 |
| NebraskaNebraska | $64.04 | $37.53 |
| New HampshireNew Hampshire | $69.05 | $39.14 |
| Northern New JerseyNew Jersey | $75.52 | $42.20 |
| Rest of New JerseyNew Jersey | $72.45 | $41.08 |
| New MexicoNew Mexico | $65.20 | $38.86 |
| NevadaNevada | $67.56 | $38.81 |
| NYC suburbs and Long Island, NYNew York | $77.89 | $43.74 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $72.90 | $41.45 |
| Queens, NYNew York | $76.95 | $43.00 |
| Rest of New YorkNew York | $65.54 | $38.25 |
| OhioOhio | $64.74 | $38.51 |
| OklahomaOklahoma | $63.64 | $37.99 |
| Portland, OROregon | $71.80 | $39.88 |
| Rest of OregonOregon | $67.17 | $38.56 |
| Metropolitan Philadelphia, PAPennsylvania | $70.13 | $40.23 |
| Rest of PennsylvaniaPennsylvania | $64.81 | $38.44 |
| Puerto RicoPuerto Rico | $68.17 | $39.13 |
| Rhode IslandRhode Island | $69.38 | $39.70 |
| South CarolinaSouth Carolina | $64.86 | $38.32 |
| TennesseeTennessee | $63.81 | $37.70 |
| Austin, TXTexas | $69.73 | $39.34 |
| Beaumont, TXTexas | $64.50 | $38.36 |
| Brazoria, TXTexas | $67.36 | $38.90 |
| Dallas, TXTexas | $67.70 | $39.09 |
| Fort Worth, TXTexas | $67.37 | $39.05 |
| Galveston, TXTexas | $67.51 | $38.99 |
| Houston, TXTexas | $68.43 | $39.91 |
| Rest of TexasTexas | $65.84 | $38.58 |
| UtahUtah | $65.51 | $38.51 |
| VirginiaVirginia | $66.71 | $38.47 |
| Virgin Islands, VIUnited States Virgin Islands | $68.17 | $39.13 |
| VermontVermont | $66.62 | $38.19 |
| Rest of WashingtonWashington | $69.68 | $39.43 |
| King County, WAWashington | $77.07 | $41.83 |
| WisconsinWisconsin | $65.16 | $37.64 |
| West VirginiaWest Virginia | $63.89 | $38.92 |
| WyomingWyoming | $67.37 | $38.64 |
85097 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.
$62.00
$84.72
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 | $84.72 | 1 |
| AL | $62.65 | 1 |
| AR | $62.00 | 1 |
| AZ | $66.47 | 1 |
| CA | $70.95–$86.06 | 29 |
| CO | $70.07 | 1 |
| CT | $71.50 | 1 |
| DC | $75.95 | 1 |
| DE | $67.36 | 1 |
| FL | $67.09–$71.81 | 3 |
| GA | $64.30–$68.80 | 2 |
| GU | $71.95 | 1 |
| HI | $71.95 | 1 |
| IA | $63.79 | 1 |
| ID | $64.09 | 1 |
| IL | $65.66–$70.36 | 4 |
| IN | $64.36 | 1 |
| KS | $63.58 | 1 |
| KY | $63.73 | 1 |
| LA | $63.66–$65.94 | 2 |
| MA | $69.83–$75.75 | 2 |
| MD | $68.40–$75.95 | 3 |
| ME | $64.34–$66.87 | 2 |
| MI | $64.94–$67.71 | 2 |
| MN | $67.65 | 1 |
| MO | $62.87–$66.11 | 3 |
| MS | $62.45 | 1 |
| MT | $67.80 | 1 |
| NC | $64.83 | 1 |
| ND | $66.81 | 1 |
| NE | $64.04 | 1 |
| NH | $69.05 | 1 |
| NJ | $72.45–$75.52 | 2 |
| NM | $65.20 | 1 |
| NV | $67.56 | 1 |
| NY | $65.54–$77.89 | 5 |
| OH | $64.74 | 1 |
| OK | $63.64 | 1 |
| OR | $67.17–$71.80 | 2 |
| PA | $64.81–$70.13 | 2 |
| PR | $68.17 | 1 |
| RI | $69.38 | 1 |
| SC | $64.86 | 1 |
| SD | $66.69 | 1 |
| TN | $63.81 | 1 |
| TX | $64.50–$69.73 | 8 |
| UT | $65.51 | 1 |
| VA | $66.71–$75.95 | 2 |
| VI | $68.17 | 1 |
| VT | $66.62 | 1 |
| WA | $69.68–$77.07 | 2 |
| WI | $65.16 | 1 |
| WV | $63.89 | 1 |
| WY | $67.37 | 1 |
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.
The exact South Dakota 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
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.92 | × 1.000 | 0.9200 |
| Practice expense | 1.06 | × 1.000 | 1.0600 |
| Malpractice | 0.05 | × 0.336 | 0.0168 |
| Total RVUs | 1.9968 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$66.69
Office: (0.92 × 1 + 1.06 × 1 + 0.05 × 0.336) × $33.4009 = $66.69
Facility: (0.92 × 1 + 0.2 × 1 + 0.05 × 0.336) × $33.4009 = $37.97
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.
How 85097 has changed in South Dakota
85097 · Office / nonfacility
$66.69
Effective 2026-10-01
The base rate is $0.21 higher than on 2025-10-01, moving from $66.48 to $66.69 (0.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$66.48changed to$66.69
- 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
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$68.21changed to$66.48
- 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.
March 9, 2024
RVU24AR
$67.10changed to$68.21
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$68.27changed to$67.10
- 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
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$68.43changed to$68.27
- 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
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$68.65changed to$68.43
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.01 changed to 1.02
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$70.32changed to$68.65
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.99 changed to 1.01
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$74.94changed to$70.32
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.12 changed to 0.99
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$92.50changed to$74.94
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.61 changed to 1.12
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$91.15changed to$92.50
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.58 changed to 1.61
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$89.87changed to$91.15
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.55 changed to 1.58
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$88.97changed to$89.87
- 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.
July 1, 2015
RVU15C
$88.53changed to$88.97
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$85.29changed to$88.53
- 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
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$85.11changed to$85.29
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.54 changed to 1.42
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $85.11
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $66.69 | $37.97 | RVU26D |
| 2026-07-01 | $66.69 | $37.97 | RVU26C |
| 2026-04-01 | $66.69 | $37.97 | RVU26B |
| 2026-01-01 | $66.69 | $37.97 | RVU26A |
| 2025-10-01 | $66.48 | $44.49 | RVU25D |
| 2025-07-01 | $66.48 | $44.49 | RVU25C |
| 2025-04-01 | $66.48 | $44.49 | RVU25B |
| 2025-01-01 | $66.48 | $44.49 | RVU25A |
| 2024-10-01 | $68.21 | $45.91 | RVU24D |
| 2024-07-01 | $68.21 | $45.91 | RVU24C |
| 2024-04-01 | $68.21 | $45.91 | RVU24B |
| 2024-03-09 | $68.21 | $45.91 | RVU24AR |
| 2024-01-01 | $67.10 | $45.16 | RVU24A |
| 2023-10-01 | $68.27 | $46.92 | RVU23D |
| 2023-07-01 | $68.27 | $46.92 | RVU23C |
| 2023-04-01 | $68.27 | $46.92 | RVU23B |
| 2023-01-01 | $68.27 | $46.92 | RVU23A |
| 2022-10-01 | $68.43 | $47.32 | RVU22D |
| 2022-07-01 | $68.43 | $47.32 | RVU22C |
| 2022-04-01 | $68.43 | $47.32 | RVU22B |
| 2022-01-01 | $68.43 | $47.32 | RVU22A |
| 2021-10-01 | $68.65 | $48.06 | RVU21D |
| 2021-07-01 | $68.65 | $48.06 | RVU21C |
| 2021-04-01 | $68.65 | $48.06 | RVU21B |
| 2021-01-01 | $68.65 | $48.06 | RVU21A |
| 2020-10-01 | $70.32 | $50.11 | RVU20D |
| 2020-07-01 | $70.32 | $50.11 | RVU20C |
| 2020-04-01 | $70.32 | $50.11 | RVU20B |
| 2020-01-01 | $70.32 | $50.11 | RVU20A |
| 2019-10-01 | $74.94 | $50.07 | RVU19D |
| 2019-07-01 | $74.94 | $50.07 | RVU19C |
| 2019-04-01 | $74.94 | $50.07 | RVU19B |
| 2019-01-01 | $74.94 | $50.07 | RVU19A |
| 2018-10-01 | $92.50 | $50.38 | RVU18D |
| 2018-07-01 | $92.50 | $50.38 | RVU18C |
| 2018-04-01 | $92.50 | $50.38 | RVU18B |
| 2018-01-01 | $92.50 | $50.38 | RVU18AR1 |
| 2017-10-01 | $91.15 | $50.24 | RVU17D |
| 2017-07-01 | $91.15 | $50.24 | RVU17C |
| 2017-04-01 | $91.15 | $50.24 | RVU17B |
| 2017-01-01 | $91.15 | $50.24 | RVU17A |
| 2016-10-01 | $89.87 | $49.77 | RVU16D |
| 2016-07-01 | $89.87 | $49.77 | RVU16C |
| 2016-04-01 | $89.87 | $49.77 | RVU16B |
| 2016-01-01 | $89.87 | $49.77 | RVU16A |
| 2015-10-01 | $88.97 | $49.09 | RVU15D |
| 2015-07-01 | $88.97 | $49.09 | RVU15C |
| 2015-04-01 | $88.53 | $48.84 | RVU15B |
| 2015-01-01 | $88.53 | $48.84 | RVU15A |
| 2014-10-01 | $85.29 | $48.03 | RVU14D |
| 2014-07-01 | $85.29 | $48.03 | RVU14C |
| 2014-04-01 | $85.29 | $48.03 | RVU14B |
| 2014-01-01 | $85.29 | $48.03 | RVU14A |
| 2013-10-01 | $85.11 | $46.67 | RVU13D |
| 2013-07-01 | $85.11 | $46.67 | RVU13C |
| 2013-04-01 | $85.11 | $46.67 | RVU13B |
| 2013-01-01 | $85.11 | $46.67 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
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
Fee sheets · Coming soon
Put 85097 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist