Surgical · General

Surgical collection of bone marrow from a patient's own body for autologous transplantation use.

Verified May 8, 2026 · 6 sources ↓

Medicare: $157.99
Total RVUs: 4.73
Global, days: 0
Region: General

Drawn from CMSFallon HealthAAPCNIHAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify harvest site(s) by anatomic location (e.g., bilateral posterior iliac crests) — 'standard site' is not sufficient for audit purposes.
Document the autologous intent explicitly: note that harvested marrow is from and intended for the same patient.
Include the underlying diagnosis with ICD-10 code; Medicare coverage under NCD 110.23 is indication-specific.
Record volume of marrow collected and number of aspiration passes performed.
Document anesthesia type used during the harvest procedure.
If billed same-day with another procedure, the operative note must support each service as distinct and separately identifiable.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 38232 covers the surgical harvesting of bone marrow from a patient for autologous transplantation — meaning the collected marrow is intended for reinfusion into the same patient, typically following high-dose chemotherapy or radiotherapy that would otherwise ablate the patient's hematopoietic system. The harvest is performed via multiple needle aspirations, most commonly from the posterior iliac crests, under general or regional anesthesia. This code sits at the end of the 38204–38232 range covering bone marrow and stem cell services.

Distinguish 38232 from 38206, which covers peripheral blood-derived hematopoietic progenitor cell harvesting. When marrow is being collected from a donor for a different recipient, 38232 is not the correct code — that scenario uses allogeneic harvesting codes. The global period is 000, so post-operative management falls outside this code's bundling. CMS NCD 110.23 governs Medicare coverage criteria for autologous stem cell transplantation; coverage is tied to specific oncologic indications, so ICD-10 diagnosis alignment is critical before billing.

Top billing specialties in the CMS Physician Utilization File include orthopedic surgery, oral surgery, and plastic and reconstructive surgery — reflecting both traditional transplant contexts and orthobiologic applications (e.g., bone marrow aspirate concentrate used in bone grafting). Payer policies on orthobiologic applications vary significantly; some commercial payers deny 38232 when billed for non-transplant musculoskeletal use, citing lack of medical necessity or investigational status.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.41
Practice expense RVU	0.87
Malpractice RVU	0.45
Total RVU	4.73
Medicare national rate	$157.99
Global period	0 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	$157.99
HOPD (APC 5243) Hospital outpatient department	$4,449.84
ASC (PI R2) Ambulatory surgical center (freestanding)	$2,389.95

Common denial reasons

The recurring reasons claims for CPT 38232 get rejected.

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

ICD-10 diagnosis does not meet payer's covered indications under NCD 110.23 or applicable LCD — common when 38232 is billed for orthobiologic/bone graft applications rather than transplant.
Bundling denial when billed same-day with a primary orthopedic procedure without modifier 59 to establish distinct procedural service.
Non-covered service denial from payers that classify bone marrow harvesting for musculoskeletal (non-transplant) use as investigational or experimental.
Missing or insufficient documentation of harvest site, volume, and autologous intent, triggering medical necessity review failure.
Incorrect code selection — allogeneic harvest billed under 38232 instead of the appropriate allogeneic code.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can 38232 be billed when bone marrow is harvested for use as a bone graft concentrate rather than a true stem cell transplant?

This is the most contested billing scenario for 38232. Some orthopedic and podiatric practices bill 38232 for bone marrow aspirate concentrate (BMAC) used in orthobiologic applications. Many commercial payers deny this, classifying it as investigational when used outside a transplant context. Check your payer's specific medical policy before billing — there is no universal rule here, and denials are common.

02What is the global period for 38232?

The global period is 000 — meaning only same-day pre- and post-service work is bundled. There is no 10- or 90-day post-op period attached to this code, so follow-up visits do not require a global-period modifier.

03How does 38232 differ from 38206?

38232 is for bone marrow harvest via needle aspiration from the marrow cavity. 38206 covers peripheral blood-derived hematopoietic progenitor cell collection via apheresis. The source and technique are different; don't use them interchangeably.

04If 38232 is performed the same day as an orthopedic procedure, what modifier is needed?

Append modifier 59 to 38232 to establish it as a distinct procedural service separate from the primary orthopedic procedure. Without 59, payers will bundle and deny the harvest. Ensure the operative note documents each service separately.

05Does Medicare require a specific diagnosis to cover 38232?

Yes. CMS NCD 110.23 governs Medicare coverage for autologous stem cell transplantation, including bone marrow harvest. Coverage is tied to specific oncologic indications. Claims billed with a diagnosis outside covered indications will deny. Verify ICD-10 alignment against the NCD before submitting.

06When is modifier 22 appropriate on 38232?

Use modifier 22 if the harvest was substantially more complex than typical — for example, prior radiation to the iliac crests, severe obesity complicating access, or failed initial aspiration requiring alternative site harvest. The operative note must explicitly document the increased time and complexity; modifier 22 without supporting documentation will be stripped on audit.

Sources & references

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

01CMS Physician Fee Schedule 2026
02CMS NCD 110.23 - Stem Cell Transplantation: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=366
03Fallon Health - Autologous Stem Cell Transplantation Clinical Coverage Criteria (Effective 09/01/2025): https://fallonhealth.org/providers/criteria-policies-guidelines/~/media/Files/ProviderPDFs/MedicalPolicies/AutoStemCell090125.ashx
04AAPC Codify - CPT 38232: https://www.aapc.com/codes/cpt-codes/38232
05NIH VSAC - CPT 38232 Descriptor: https://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2020/code/38232/info
06AAOS Resident Guide: Modifiers: https://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf

Mira AI Scribe

Mira's AI scribe captures harvest site by name (e.g., bilateral posterior iliac crests), number of aspiration passes, volume collected, anesthesia type, and explicit confirmation that marrow is autologous. It also flags the treating diagnosis code in the dictation. This prevents the two most common denial triggers: vague site documentation that fails audit and an ICD-10 mismatch that fails NCD 110.23 medical necessity review.

See how Mira captures CPT 38232 documentation