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 |