Surgical · General

Diagnostic bone marrow aspiration procedure — any number of aspirations performed for diagnostic evaluation, reported once regardless of how many passes are made.

Verified May 8, 2026 · 7 sources ↓

Medicare: $167.67
Total RVUs: 5.02
Global, days
Region: General

Drawn from CMSAAPCApsmedbillOutsourcestrategies

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Specify the anatomic site of aspiration (iliac crest — left or right — or sternum) by name, not just 'standard approach'
Confirm the diagnostic intent of the procedure; notes referencing therapeutic or grafting use will trigger NCCI bundling denials
Document the number of aspiration passes and needle reinsertion attempts, even though one unit covers all passes
State whether a biopsy was also performed, on which bone, and through which incision — required to choose between 38220, 38221, and 38222
If aspiration smear interpretation (85097) or cell block interpretation (88305) is billed by the same provider, note that the provider personally performed and interpreted the specimen

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

50 Bilateral procedure 59 Distinct service 26 Professional component RT Right side LT Left side 52 Reduced services 76 Repeat, same physician 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 38220 covers diagnostic bone marrow aspiration(s) performed at the sternum or iliac crest. Any number of aspirations made during the same encounter are captured by this single code — do not stack units. The code is strictly diagnostic; therapeutic applications, including bone marrow aspiration for platelet-rich stem cell injection or other musculoskeletal treatment purposes, are not reportable here.

The most consequential bundling rule: 38220 cannot be billed with 38221 (biopsy alone) when both procedures are performed on the same bone at the same encounter. If both aspiration and biopsy are done ipsilaterally in the same session, the correct code is 38222. You can report 38220 and 38221 together only when the two procedures are performed on different bones (e.g., contralateral iliac crests) or at separate patient encounters on the same date — append modifier 59 to the secondary code to document the distinct site. Bilateral same-bone procedures take modifier 50.

38220 is also explicitly excluded from spine surgery contexts. NCCI 2026 Chapter 4 prohibits separate reporting of 38220 with spinal osteotomy, arthrodesis, fusion, laminectomy, decompression, or vertebral corpectomy. For orthopedic spine cases requiring bone marrow aspiration as autograft, the correct add-on is +20939. Aspiration smear interpretation can be separately reported under 85097 by the same provider who performed the procedure; if a cell block is prepared, use 88305.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.17
Practice expense RVU	3.76
Malpractice RVU	0.09
Total RVU	5.02
Medicare national rate	$167.67
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$167.67
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI P3) Ambulatory surgical center (freestanding)	$126.55

Common denial reasons

The recurring reasons claims for CPT 38220 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

38220 billed alongside 38221 for same-bone same-session aspiration and biopsy — correct code is 38222
38220 billed separately with a spine procedure (fusion, laminectomy, decompression) — NCCI bundles these without an override modifier; use +20939 for spine autograft instead
38220 used for bone marrow aspiration performed as part of a platelet-rich stem cell or other therapeutic musculoskeletal injection — payers deny based on NCCI Chapter 4 language
Modifier 59 appended to 38220 + 38221 on the same bone at the same encounter — modifier 59 is not a valid override for same-bone same-session aspiration/biopsy combos

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill 38220 and 38221 together when I do both an aspiration and a biopsy?

Only if the two procedures are performed on different bones (e.g., contralateral iliac crests) or at separate patient encounters on the same date. For the far more common scenario — aspiration and biopsy on the same bone in the same session — bill 38222 instead and append modifier 59 to neither.

02My orthopedic surgeon aspirated bone marrow during a spinal fusion for autograft. Can I report 38220?

No. NCCI 2026 Chapter 4 explicitly prohibits reporting 38220 separately with spinal arthrodesis, fusion, laminectomy, or decompression. Use add-on code +20939 for bone marrow aspiration performed for spine bone grafting.

03The surgeon did three separate aspiration passes at the same iliac crest site. Do I report 38220 three times?

No. Multiple aspirations from the same site at the same encounter are captured by a single unit of 38220. The code covers any number of aspirations performed during the procedure.

04Can I report 38220 for bone marrow aspiration performed to prepare a platelet-rich stem cell injection?

No. NCCI policy explicitly excludes 38220 from being reported separately for bone marrow aspiration used in platelet-rich stem cell injections or other therapeutic musculoskeletal applications. This is a bright-line rule, not payer-variable.

05How do I report the interpretation of the bone marrow aspirate?

If the same provider who performed 38220 also interprets the aspirate smear, add 85097 for smear interpretation. If a cell block is prepared from the aspirate, use 88305 for cell block interpretation. Both are separately reportable by the performing provider.

06When is modifier 50 appropriate with 38220?

When aspiration is performed bilaterally — e.g., both iliac crests are aspirated at the same session without a biopsy on either side. Bill 38220 with modifier 50. If one side gets aspiration only and the other gets aspiration plus biopsy, you need to sort each side to the correct code before applying laterality modifiers.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the anatomic site (left iliac crest, right iliac crest, or sternum), number of aspiration passes, whether a concurrent biopsy was performed and on which bone, and the clinical indication driving the procedure. That documentation prevents the two most common denials: wrong code selection between 38220, 38221, and 38222, and NCCI bundling flags when aspiration is performed alongside a spine or musculoskeletal procedure.

See how Mira captures CPT 38220 documentation