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    v1.0.28
    OpenPayerBilling CodesBone Marrow or Stem Cell Services/ProceduresCPT cpt-38220-bone-marrow-aspiration-diagnostic
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    CPT 38220: Bone Marrow Aspiration, Diagnostic

    Medicare pays $174 and commercial payers pay $388 on average nationally for this procedure.

    CPT code 38220 describes a diagnostic bone marrow aspiration in which a provider inserts a long, large-bore needle into the sternum or pelvic bone to aspirate marrow tissue; service type: diagnostic aspiration; typical site of service: hospital procedure room, outpatient surgical center, or clinic where sterile bone marrow aspiration is performed.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only).

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    National Reimbursement Benchmarks

    Nationally, Medicare’s mean rate sits at $174.30 while BUCA’s average commercial mean is $387.50, showing BUCA pays roughly $213.20 more on average than Medicare for CPT 38220. That divergence highlights a sizable split between Medicare reimbursement and certain commercial contracts, with BUCA notably above both the overall commercial cohort means and Medicare.

    Dispersion varies across payers: Blue Cross Blue Shield has one of the widest interquartile ranges at $231.60 (P75 $674.90 minus P25 $443.00), followed by UnitedHealth Group at $159.10 (P75 $292.40 minus P25 $136.30). Aetna displays a tighter spread of $101.40 (P75 $139.40 minus P25 $38.00), and Cigna’s spread is $164.20 (P75 $266.70 minus P25 $102.50). BUCA’s IQR is $192.70 (P75 $485.40 minus P25 $292.70). These differences signal varied variability in contracted rates across payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with fatigue, easy bruising, and an abnormal complete blood count is referred to hematology. Peripheral smear suggests pancytopenia; the clinician suspects myelodysplastic syndrome versus aplastic anemia. The hematologist schedules a diagnostic bone marrow aspiration to obtain marrow cells for morphology, cytogenetics, flow cytometry, and molecular testing. On the day of service the patient is positioned supine (for sternal aspiration) or prone/decubitus (for posterior iliac crest aspiration) depending on site selection. Local anesthesia is administered; the provider inserts a long, large-bore needle into the sternum or pelvic bone and aspirates bone marrow. Specimens are placed in appropriate media and sent to pathology and the laboratory. The visit is typically performed in an outpatient ambulatory clinic, hospital outpatient department, or inpatient ward under the care of a hematology/oncology or hematology physician. Indications for this diagnostic aspiration include evaluation of cytopenias, staging or assessment of leukemia such as C92.10 or C91.00, evaluation of suspected myelodysplastic syndrome D46.9, assessment of marrow failure D61.9, or thrombotic/platelet disorders such as D47.3 when marrow examination is clinically required. Procedural documentation includes indication, consent, site, anesthesia, specimen collection details, complications (if any), and specimens sent to specific labs.

    Related CPT Codes

    CPT CodeDescription

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RH0003XHematology & Oncology PhysicianAn internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy t…
    207RH0000XHematology (Internal Medicine) PhysicianAn internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
    207RX0202XMedical Oncology PhysicianAn internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on a…
    163WM0705XMedical-Surgical Registered NurseNursing Service Providers · Registered Nurse
    1744R1102XResearch Study SpecialistOther Service Providers · Specialist
    207RR0500XRheumatology PhysicianAn internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, comm…
    261QR0206XMammography Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    246QM0706XMedical TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Chimeric Antigen Receptor (CAR) T-Cell TherapyColorado Rocky Mountain Health Plans2026-08-01
    Allogeneic Hematopoietic Progenitor Cell TherapyAmbetter Georgia2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)UnitedHealthcare2026-08-01
    Reblozyl (luspatercept-aamt) Medical Benefit Drug PolicyUnitedHealthcare2026-08-01

    Related Codes

    CPT-38204-DONOR-SEARCH-HPC-ACQUISITION-MANAGEMENT

    CPT 38204: Donor Search and Hematopoietic Progenitor Cell Acquisition

    CPT-38205-APHERESIS-HPC-PERIPHERAL-BLOOD-HARVEST

    CPT 38205: Apheresis Hematopoietic Progenitor Cell Harvest

    CPT-38206-AUTOLOGOUS-HPC-APHERESIS-COLLECTION

    CPT 38206: Autologous Hematopoietic Progenitor Cell Apheresis

    CPT-38207-HEMATOPOIETIC-PROGENITOR-CELL-PRESERVATION-STORAGE

    CPT 38207: Management of Hematopoietic Progenitor Cell Preservation

    CPT-38208-THAW-PREPARATION-HEMATOPOIETIC-PROGENITOR-CELLS

    CPT 38208: Thawing of Previously Frozen Hematopoietic Progenitor Cells

    CPT-38209-HPC-THAWING-AND-WASHING-FOR-TRANSPLANTATION

    CPT 38209: Thaw and Wash Hematopoietic Progenitor Cells for Transplant

    CPT-38210-T-CELL-DEPLETED-HEMATOPOIETIC-PROGENITOR-CELL-PREPARATION

    CPT 38210: T-Cell–Reduced Hematopoietic Progenitor Cell Preparation

    CPT-38211-HEMATOPOIETIC-PROGENITOR-CELL-TUMOR-REDUCTION-PROCESSING

    CPT 38211: Hematopoietic Progenitor Cell Enrichment and Tumor Depletion

    CPT-38212-HPC-RED-CELL-DEPLETION-PREPARATION

    CPT 38212: HPC Red Cell Depletion for Transplant Preparation

    CPT-38213-HPC-SOLUTION-PREPARATION-PLATELET-REDUCTION

    CPT 38213: Hematopoietic Progenitor Cell Preparation to Reduce Platelets

    Showing 1–10 of 20

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Relationship to This Procedure
    38221Bone marrow; diagnostic biopsy(ies) onlyA biopsy (core) may be performed at the same or adjacent site when a core specimen is required in addition to aspiration; distinct code when only biopsy performed.
    38222Bone marrow; diagnostic aspiration(s) and biopsy(ies), same siteUse when both aspiration and biopsy are performed at the same site; represents combined service and is distinct from aspiration-only code 38220.