Billing code 38221: Bone marrow biopsyMedicare rate & RVUs in Utah
Reports needle or trocar sampling of bone marrow for diagnostic evaluation when a core biopsy is performed without marrow aspiration.
Medicare pays $159.33 for 38221 in the office in Utah (Utah). 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.
On this page 9 sections
What 38221 covers
A clinician obtains a core of marrow through a needle or trocar, most often from the posterior iliac crest, to evaluate suspected or known marrow disease. Hematologists and oncologists commonly perform the procedure in an office, clinic, or hospital setting, often using local anesthesia. Typical indications include unexplained cytopenias, suspected leukemia or lymphoma, plasma cell disorders, and assessment of marrow involvement. The specimen is sent for pathologic evaluation.
Report 38221 when a diagnostic core biopsy is performed without aspiration; when both biopsy and aspiration are performed, use 38222 instead. Documentation should identify the indication, biopsy site and side, and the procedure performed. For bilateral biopsies, CMS pays 150% when modifier 50 is reported. When this service and another procedure subject to the multiple-procedure rule are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
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.
38221 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $159.33 | $56.67 |
How the 38221 rate is calculated
Each of 38221’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 · 38221
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.25Practice expense 3.64Malpractice 0.11
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 38221
The CMS indicators that decide how 38221 is paid alongside other services.
CMS payment indicators · 38221
Bone marrow biopsy
| 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
38221 without 50 · national office
$167.00
Bone marrow biopsy
38221-50 · Bilateral: 150%
$250.50
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).
38221 compared with similar codes
Compare codes
38221 vs 38220 vs 38222 vs 38230: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 38220Marrow aspiration
- 38220 reports diagnostic marrow aspiration alone. Choose 38221 when a core biopsy is performed without aspiration.
- 38222Bone marrow exam
- 38222 represents diagnostic marrow aspiration and core biopsy together. Use 38221 when the procedure is limited to the core biopsy.
- 38230Marrow harvest
- 38230 is for harvesting marrow for allogeneic transplantation, not for obtaining a diagnostic core specimen.
38221 billing questions
When should 38221 be chosen over 38222?
Use 38221 for a diagnostic marrow core biopsy without aspiration. When both a biopsy and aspiration are performed, report 38222.
Can marrow aspiration be reported separately with 38221?
When aspiration and biopsy are both performed, use 38222 rather than separately reporting 38220 with 38221.
How is a bilateral bone marrow biopsy reported?
Report modifier 50 for a bilateral procedure; CMS pays 150% under the supplied bilateral rule. Document the biopsy at both sites.
What documentation supports 38221?
Document the diagnostic indication, the site and side sampled, and that a needle or trocar core biopsy was performed without aspiration.
How does the multiple-procedure reduction affect 38221?
When another procedure subject to the rule is performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
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
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