Summary & Overview
HCPCS G0364: Bone Marrow Aspiration with Biopsy, Single Incision
HCPCS Level II code G0364 denotes a combined bone marrow aspiration and core biopsy performed through the same incision on the same date of service. This bundled procedural descriptor matters nationally because it clarifies reporting for a common hematology-oncology diagnostic encounter and affects coding consistency, claim adjudication, and clinical documentation. Accurate use of the code informs procedural counts, utilization monitoring, and payment processing across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for combined marrow sampling, guidance on where this service typically occurs (hospital outpatient departments and ambulatory surgical centers), and what to expect in payer coverage and claims workflows. The publication summarizes benchmarks and policy-relevant considerations such as bundling implications, documentation elements that justify a combined aspiration and biopsy, and common areas of claims denial or additional review. Where specific input data is missing, the text notes that information is not available in the input.
Billing Code Overview
HCPCS Level II code G0364 describes a bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service. This procedure combines two diagnostic sampling techniques—aspiration and core biopsy—into a single operative encounter using one incision.
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Service type: Diagnostic invasive procedure involving bone marrow sampling
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Typical site of service: Hospital outpatient department or ambulatory surgical center where minor surgical procedures and pathology specimens are obtained
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with persistent unexplained anemia and thrombocytopenia is referred to hematology for diagnostic evaluation. The hematologist performs a bone marrow aspiration and bone marrow biopsy through the same incision on the posterior superior iliac crest during a single visit to obtain marrow aspirate for flow cytometry and cytogenetics and a core biopsy for morphology and immunohistochemistry. The clinical workflow includes informed consent, local anesthetic infiltration, aseptic preparation, aspiration of liquid marrow followed immediately by a core biopsy using the same puncture site, specimen labeling and processing, brief post-procedure observation for bleeding or pain, and discharge with wound care instructions and follow-up for results and potential further treatment decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure | Use when an evaluation and management service is distinct from the biopsy/aspiration on the same date |
59 | Distinct procedural service | Use if another procedure performed on the same day is distinct from the marrow procedure and not typically billed together |