Summary & Overview
CPT 38220: Bone Marrow Diagnostic Aspiration Only
Headline: CPT 38220 — Bone Marrow Diagnostic Aspiration Only
Lead: CPT 38220 denotes a bone marrow diagnostic aspiration performed to collect marrow fluid for laboratory and cytologic evaluation. The procedure is an essential diagnostic tool in hematology for assessing marrow involvement in anemias, leukemias, myelodysplastic syndromes, and other marrow disorders.
What it represents and why it matters: CPT 38220 covers the aspiration-only marrow procedure (no core biopsy). Nationally, the code guides billing and clinical documentation for a common, minimally invasive diagnostic test that informs diagnosis, staging, and treatment monitoring in hematologic disease. Clear coding supports appropriate reimbursement and accurate reporting of hematology services across outpatient and office settings.
Key payers covered: This summary addresses coverage considerations for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Overview of reader takeaways: Readers will find concise information on the clinical scope of the procedure, typical sites of service, payer landscape, and related coding context. The publication summarizes common modifiers and related CPT codes for documentation and billing alignment, clinical scenarios where an aspiration-only approach is used, and typical diagnostic indications. It also notes where input data is missing and signals items requiring payer-specific policy review. The content is intended to support coding staff, billing professionals, and clinicians seeking a clear, national-level briefing on CPT 38220.
CPT Code Overview
CPT 38220 describes a bone marrow diagnostic aspiration only, a hematologic diagnostic procedure performed to obtain marrow fluid for cytologic, morphologic, and laboratory evaluation. This service is typically used to evaluate blood disorders, marrow cellularity, and malignant or pre-malignant hematologic conditions.
Service type: Diagnostic hematologic procedure
Typical site of service: Office or hospital outpatient setting (for example, Office (POS 11) or Hospital Outpatient)
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with pancytopenia and fatigue presents to a hematology clinic for evaluation. The hematologist obtains informed consent and performs a diagnostic bone marrow aspiration at the posterior iliac crest in the outpatient procedure room. Local anesthesia is used; marrow aspirate is obtained for morphology, flow cytometry, cytogenetics, and molecular testing. The aspirate specimen is processed by the clinical laboratory; the physician documents indications, technique, site, amount of material obtained, and any complications in the procedure note. The visit typically occurs in an office (POS 11) or hospital outpatient setting and is billed as a diagnostic hematologic procedure when biopsy is not performed.
Coding Specifications
Modifier 26 - Professional Component
- Use when reporting only the physician's professional work for interpretation or procedure performance without technical resources.
Modifier TC - Technical Component
- Use when reporting only the facility or laboratory technical resources (equipment, supplies, and non-physician staff) for specimen processing or testing when the physician component is billed separately.
Modifier 59 - Distinct Procedural Service
- Use when the aspiration is a separate and distinct procedure from other services performed on the same day at the same anatomic site, supporting that the service is not bundled.
Associated Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
207RH0003X | Hematology & Oncology Physician |
207RH0000X | Hematology Physician |
207RX0202X | Medical Oncology Physician |
Related Diagnoses
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D61.9— Aplastic anemia, unspecified- Aplastic anemia can present with pancytopenia prompting diagnostic bone marrow aspiration to evaluate cellularity and etiology.
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C92.10— Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission- Bone marrow aspiration is used to assess disease status, cellular morphology, and obtain material for molecular testing in active disease.
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D46.9— Myelodysplastic syndrome, unspecified- Aspiration helps assess marrow dysplasia, blast percentage, and guides diagnosis and risk stratification.
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C91.00— Acute lymphoblastic leukemia, not having achieved remission- Aspiration is performed to evaluate blast count, marrow involvement, and response to therapy.
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D47.3— Essential (hemorrhagic) thrombocythemia- Aspiration may be used to evaluate marrow megakaryocyte morphology and assist in diagnosis or rule out other myeloproliferative disorders.
Related CPT Codes
| CPT Code | Description | Relationship to 38220 |
|---|---|---|
38221 | Bone marrow; diagnostic biopsy(ies) only | Alternative procedure when only a core biopsy is obtained instead of aspiration; used when tissue core is required for histology. |
38222 | Bone marrow; diagnostic aspiration(s) and biopsy(ies), same site | Combined procedure when both aspiration and biopsy are performed at the same site; commonly used instead of 38220 when both specimens are obtained. |
Common usage notes:
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38221is used as an alternative to38220when a biopsy (core) alone is performed. -
38222is used when both aspiration and biopsy are performed; it replaces billing both38220and38221for the same site on the same date.
National Reimbursement Benchmarks
National commercial mean rates vary substantially versus Medicare: BUCA (average commercial) posts a mean of $165.01, which is about $9 lower than the Medicare mean of $174.34. UnitedHealth Group and Cigna have the highest commercial means ($227.78 and $211.40 respectively), while Aetna reports the lowest mean at $108.30.
Dispersion measured as the interquartile range (P75 − P25) is widest for UnitedHealth Group (271.00 − 146.50 = $124.50) and Cigna (250.00 − 134.50 = $115.50), indicating greater variability in allowed rates. Aetna shows the tightest spread (123.67 − 75.67 = $48.00), followed by Medicare (181.00 − 161.00 = $20.00), indicating more consistency in those payers' rates.
The table and chart below present the full payer breakdown of mean rates and key percentiles for CPT 38220.
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.