Billing code 38220: Marrow aspirationMedicare rate & RVUs
Reports needle aspiration of bone marrow for diagnostic evaluation, such as obtaining marrow material for hematologic testing or microscopic review.
Medicare pays $167.67 for 38220 nationally in the office and $55.45 in a hospital or facility. Local office rates run $148.51–$226.09.
Medicare rate · 38220
Marrow aspiration
- Work RVUs
- 1.17
- Total RVUs
- 5.02
- Global days
- XXX
National rate · 2026
$167.67
Office setting, before claim adjustments.
See every locality for 38220 →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.
On this page 10 sections
What 38220 covers
A clinician advances an aspiration needle into marrow, commonly at the posterior iliac crest, and withdraws liquid marrow for diagnostic studies. Hematologists and oncologists often perform the procedure in an office, clinic, or hospital setting; interventional radiologists may perform it with image guidance when clinically needed. The aspirate can support evaluation of suspected marrow disorders, cytopenias, or hematologic malignancy. This code describes aspiration, not removal of a core tissue specimen.
Select this service when diagnostic marrow is aspirated without a marrow biopsy during the encounter. When both aspiration and biopsy are performed, use 38222 rather than separately reporting 38220 and 38221. Documentation should identify the diagnostic purpose, procedure site, and aspiration performed. 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 others at 50%. For a bilateral procedure reported with modifier 50, CMS pays at 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 38220 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
$148.51 to $226.09
109 of 109 payment localities
38220 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.
$148.51
$202.55
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 | $194.03 | 1 |
| AL | $150.67 | 1 |
| AR | $148.51 | 1 |
| AZ | $163.35 | 1 |
| CA | $179.00–$226.09 | 29 |
| CO | $175.52 | 1 |
| CT | $178.76 | 1 |
| DC | $192.48 | 1 |
| DE | $166.06 | 1 |
| FL | $163.66–$177.42 | 3 |
| GA | $154.69–$170.40 | 2 |
| GU | $183.61 | 1 |
| HI | $183.61 | 1 |
| IA | $155.18 | 1 |
| ID | $156.04 | 1 |
| IL | $158.44–$173.66 | 4 |
| IN | $156.96 | 1 |
| KS | $154.13 | 1 |
| KY | $153.48 | 1 |
| LA | $153.10–$160.67 | 2 |
| MA | $174.34–$193.31 | 2 |
| MD | $169.32–$192.48 | 3 |
| ME | $156.49–$165.43 | 2 |
| MI | $157.13–$165.34 | 2 |
| MN | $169.20 | 1 |
| MO | $150.26–$161.65 | 3 |
| MS | $149.43 | 1 |
| MT | $167.67 | 1 |
| NC | $158.17 | 1 |
| ND | $165.89 | 1 |
| NE | $156.13 | 1 |
| NH | $172.45 | 1 |
| NJ | $181.08–$190.43 | 2 |
| NM | $157.85 | 1 |
| NV | $167.30 | 1 |
| NY | $160.50–$196.49 | 5 |
| OH | $156.77 | 1 |
| OK | $153.56 | 1 |
| OR | $166.28–$181.47 | 2 |
| PA | $157.21–$174.11 | 2 |
| PR | $169.01 | 1 |
| RI | $172.23 | 1 |
| SC | $157.68 | 1 |
| SD | $165.68 | 1 |
| TN | $154.85 | 1 |
| TX | $156.16–$174.69 | 8 |
| UT | $159.83 | 1 |
| VA | $164.65–$192.48 | 2 |
| VI | $169.01 | 1 |
| VT | $164.93 | 1 |
| WA | $174.12–$197.58 | 2 |
| WI | $160.32 | 1 |
| WV | $152.52 | 1 |
| WY | $166.89 | 1 |
How the 38220 rate is calculated
Each of 38220’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 · 38220
RVUs × geographic indexes × conversion factor
Work1.17
1.17 RVUs× 1.000 GPCI
Practice expense3.76
3.76 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
5.0200
Conversion factor
$33.4009
Medicare rate
$167.67
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 38220
The CMS indicators that decide how 38220 is paid alongside other services.
CMS payment indicators · 38220
Marrow aspiration
| 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
38220 without 50 · national office
$167.67
Marrow aspiration
38220-50 · Bilateral: 150%
$251.50
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).
38220 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 38221Bone marrow biopsy
- Choose 38221 when a marrow core biopsy is obtained without diagnostic aspiration. Aspiration alone is reported with 38220.
- 38222Bone marrow exam
- Choose 38222 when diagnostic aspiration and biopsy are both performed during the encounter; do not report 38220 and 38221 separately for that combination.
- 38230Marrow harvest
- 38230 is for allogeneic bone marrow harvest, a donor collection service rather than diagnostic aspiration.
38220 billing questions
How is 38220 different from 38221?
38220 represents aspiration of liquid marrow for diagnostic testing; 38221 represents obtaining a core biopsy specimen. Use 38222 when both aspiration and biopsy are performed.
Can 38220 and 38221 be reported together for the same encounter?
When both diagnostic aspiration and biopsy are performed, report 38222 rather than separately reporting 38220 and 38221.
Does 38220 include interpretation of the marrow specimen?
The procedure code represents obtaining the aspirate. A pathologist may separately report marrow smear interpretation, such as 85097, when that service is performed and documented.
How does CMS price bilateral aspiration?
CMS pays a bilateral procedure reported with modifier 50 at 150%. Document the bilateral procedure and report modifier 50 when appropriate.
What happens when other procedures are performed in the same session?
Under the standard multiple-procedure reduction, CMS pays the highest-valued procedure in full and the other applicable procedures at 50% when performed in the same session.
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
Put 38220 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →