Summary & Overview
CPT 38221: Bone Marrow Biopsy, Needle or Trocar, Unilateral or Bilateral
CPT code 38221 represents a bone marrow biopsy performed with a needle or trocar, either on one or both sides. This procedure is a cornerstone in the diagnosis and management of hematologic disorders, including leukemias, anemias, and other conditions affecting the blood and lymphatic systems. Nationally, bone marrow biopsies are frequently performed in office settings by hematology and oncology specialists, making this code highly relevant across clinical practices.
Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical context, and policy updates related to 38221. Readers will gain insights into typical sites of service, associated clinical indications, and related procedural codes. The summary also highlights common billing practices, such as the use of modifier 59 for distinct procedural services, and outlines the relevant provider taxonomies.
This article serves as a resource for understanding national benchmarks, payer policies, and the clinical significance of bone marrow biopsy procedures. It is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on coding, coverage, and clinical applications for CPT code 38221.
CPT Code Overview
CPT code 38221 is used to report a bone marrow biopsy performed with a needle or trocar, either unilaterally or bilaterally. This procedure is classified under Hemic and Lymphatic System Procedures and is typically conducted in an office setting (Place of Service 11). Bone marrow biopsies are essential for diagnosing and monitoring various hematologic conditions, providing critical information for patient management.
Clinical & Coding Specifications
Clinical Context
A patient presents to a hematology or oncology clinic with symptoms such as unexplained anemia, abnormal white blood cell counts, or other hematologic abnormalities. The provider suspects a disorder affecting the bone marrow, such as myelodysplastic syndrome, leukemia, or aplastic anemia. To confirm the diagnosis and guide treatment, the provider performs a bone marrow biopsy using a needle or trocar, either unilaterally or bilaterally. The procedure is typically performed in the office setting (Place of Service 11) by a hematology or oncology physician.
Coding Specifications
- Modifier
59: Used to indicate a distinct procedural service when the bone marrow biopsy is performed separately from other procedures, ensuring proper reimbursement when multiple services are provided.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207RH0003X | Hematology & Oncology Physician |
207RH0000X | Hematology Physician |
207RX0202X | Medical Oncology Physician |
- These taxonomies represent providers specializing in hematology, oncology, or both, who are qualified to perform bone marrow biopsies.
Related Diagnoses
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D46.9- Myelodysplastic syndrome, unspecified- Bone marrow biopsy is essential for diagnosing and classifying myelodysplastic syndromes.
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C92.10- Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission- Biopsy helps assess disease status and response to therapy in chronic myeloid leukemia.
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D61.9- Aplastic anemia, unspecified- Bone marrow biopsy is required to confirm aplastic anemia and exclude other causes of cytopenia.
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C91.00- Acute lymphoblastic leukemia, not having achieved remission- Biopsy is used to diagnose and monitor acute lymphoblastic leukemia.
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D47.9- Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified- Biopsy assists in evaluating neoplasms of uncertain behavior affecting the bone marrow.
Related CPT Codes
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38220- Diagnostic bone marrow, aspiration only- Used when only a bone marrow aspiration is performed, without biopsy. Often performed together with
38221for comprehensive evaluation.
- Used when only a bone marrow aspiration is performed, without biopsy. Often performed together with
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38222- Diagnostic bone marrow; biopsy(ies) and aspiration(s)- Used when both biopsy and aspiration are performed during the same encounter. May be used as an alternative to
38221if both procedures are clinically indicated.
- Used when both biopsy and aspiration are performed during the same encounter. May be used as an alternative to
-
These codes are commonly used together or as alternatives depending on the clinical need for biopsy, aspiration, or both.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 38221 is $173.51, closely aligned with the BUCA (average commercial) mean rate of $171.10. This suggests that, on average, Medicare reimbursement is comparable to the blended commercial benchmark for this service.
Rate dispersion varies significantly across payers. Aetna exhibits the tightest spread, with a difference of $50.67 between its 75th and 25th percentiles, indicating less variability in contracted rates. In contrast, UnitedHealth Group shows the widest dispersion, with a $116.92 gap between its 75th and 25th percentiles, reflecting greater variability in commercial rates. Blue Cross Blue Shield, Cigna, and BUCA also display broader ranges, while Medicare's spread is relatively narrow at $19.00.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.