Summary & Overview
CPT 38222: Bone Marrow Aspiration and Biopsy, Diagnostic
CPT code 38222 represents a combined bone marrow aspiration and core biopsy performed to obtain marrow tissue for diagnostic evaluation. This procedure is central to diagnosing hematologic disorders, staging malignancies, and guiding treatment decisions, making it a commonly billed invasive diagnostic service across inpatient and outpatient settings. Nationally, consistent coding and clear documentation for 38222 support appropriate clinical management and payer adjudication.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a synthesis of clinical context and coding intent, typical sites of service, and the payer landscape that frames coverage and claims handling. The publication also outlines common billing considerations and where stakeholders should look for policy updates that affect reimbursement and prior authorization requirements.
The report is structured to help billing and compliance professionals, clinicians, and policy staff quickly locate benchmarks and policy notes, understand typical clinical use cases, and identify areas where documentation supports medical necessity. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 38222 describes a diagnostic bone marrow aspiration and biopsy procedure in which the provider obtains a scraping or sample of bone marrow tissue using both aspiration and biopsy techniques. Bone marrow aspiration is typically performed prior to the biopsy when both are performed.
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Service type: Diagnostic bone marrow aspiration and biopsy
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Typical site of service: Ambulatory clinic, hospital inpatient unit, or outpatient surgical center depending on clinical indication and patient status
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient presents with persistent unexplained anemia, thrombocytopenia, and fatigue. Peripheral blood smear shows dysplastic changes and circulating blasts. The hematology team schedules a diagnostic bone marrow evaluation to determine the cause, including assessment for myelodysplastic syndrome or acute leukemia. The procedure is performed in an outpatient procedure suite or hospital inpatient room under local anesthesia with conscious sedation as needed. Bone marrow aspiration is performed first to obtain marrow fluid for cytology, flow cytometry, cytogenetics, and molecular testing, followed by a core biopsy using a trephine to obtain a tissue core for histopathology. Samples are labeled and sent to the pathology laboratory for immediate and ancillary testing. Postprocedure monitoring includes assessment of hemostasis, vital signs, and observation for complications such as bleeding or infection before discharge with aftercare instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s professional portion if the technical component is billed separately |
52 | Reduced services |