The main bone marrow biopsy CPT code is 38221, which covers a core needle biopsy of bone marrow. A diagnostic aspiration alone is billed with 38220, and when both an aspirate and a core biopsy are taken through the same incision in the same session, the correct code is 38222. Picking the right one depends on exactly what was sampled, how many sites were used, and what the procedure note documents. This guide walks through each code, the related pathology and imaging codes, and the documentation habits that keep claims clean.
What a Bone Marrow Biopsy Involves
Coding is easier when you understand the procedure itself. In hematology, a bone marrow examination usually has two parts, both taken from the posterior iliac crest under local anesthesia:
- Aspiration: liquid marrow is drawn into a syringe and spread on slides or sent for flow cytometry, cytogenetics, and molecular tests.
- Core (trephine) biopsy: a small cylinder of bone marrow tissue is removed to assess cellularity, fibrosis, and infiltration.
For a clinical overview of each step, see our article on how a bone marrow biopsy is performed. The billing distinction between these two components is the single most common source of coding errors.
Bone Marrow Biopsy CPT Codes at a Glance
CPT, or Current Procedural Terminology, is the standardized code set maintained by the American Medical Association and used for billing procedures in the United States. The table below lists the codes most relevant to bone marrow sampling.
| CPT code | Description | When to use |
|---|---|---|
| 38220 | Diagnostic bone marrow aspiration(s) | Aspirate only, no core taken |
| 38221 | Diagnostic bone marrow biopsy(ies) | Core biopsy only, no aspirate |
| 38222 | Diagnostic bone marrow biopsy(ies) and aspiration(s) | Both core and aspirate through the same incision, same session |
| 38230 | Bone marrow harvesting for transplantation; allogeneic | Collection from a donor for another person |
| 38232 | Bone marrow harvesting for transplantation; autologous | Collection for the patient’s own later use |
Before 38222 was introduced, the combined procedure was reported with 38221 plus a separate add-on code. That approach is no longer correct, so older templates and chargemasters are worth auditing.
Choosing Between 38220, 38221, and 38222
Aspirate only
Use 38220 when the operator obtains only liquid marrow. This happens in some follow-up studies, for example when only flow cytometry or molecular testing is needed to monitor a known hematological condition.
Core only
Use 38221 when a core is taken without an aspirate. A classic scenario is a dry tap, where no fluid can be aspirated because the marrow is packed with cells or scarred by fibrosis. If an aspiration was attempted but failed, document the attempt; payer policies differ on how a failed attempt is reported.
Both through the same incision
Use 38222 when both samples are obtained in one session through one skin incision. Do not report 38220 and 38221 together for the same site; the combined code replaces them.
Bilateral procedures
Some protocols, particularly lymphoma staging, sample both iliac crests. Codes are reported per session rather than per needle pass, but separate sites may qualify for a bilateral or distinct-site modifier. Payers vary on whether they want modifier 50, RT and LT, or a distinct-procedure modifier, so check the specific payer policy.
Related Pathology and Imaging Codes
The procedure code covers only the collection. The laboratory and pathology work is billed separately, usually by the pathologist or laboratory. Common companion codes include:
- 85097 for interpretation of the bone marrow smear.
- 88305 for surgical pathology examination of the bone marrow core.
- 88311 for decalcification of the core, which is almost always needed.
- 88313 for special stains such as iron or reticulin.
- 88342 for immunohistochemistry.
- 88184 to 88189 for flow cytometry technical and interpretation components.
If CT guidance was used to place the needle, an imaging guidance code such as 77012 may be reported, provided the images and interpretation are documented.
Linking the Code to the Right Diagnosis
Every CPT code must be paired with an ICD-10-CM diagnosis code that justifies medical necessity. Common indications include unexplained anemia, thrombocytopenia, or neutropenia; suspected or known leukemia, lymphoma, or myeloma; and bone marrow disorders such as myelodysplastic syndromes and aplastic anemia.
Code to the highest specificity the record supports. If the biopsy is done to investigate a symptom, code the sign or abnormal finding rather than a suspected diagnosis that hasn’t been confirmed. For established disease being restaged or monitored, the confirmed diagnosis is used, with remission status where the code set requires it.
Documentation Checklist
A clean procedure note protects both the claim and the patient. It should record:
- The indication and relevant blood disorder or abnormal result.
- Consent, anesthesia used, and patient position.
- The site and side, and whether one or both crests were sampled.
- Exactly which samples were obtained: aspirate, core, or both.
- Any failed aspiration attempt and the reason.
- Imaging guidance, if used.
- Specimens sent and the tests requested.
- Complications, or a statement that there were none.
Key Takeaways
- 38221 is the core biopsy code, 38220 is aspiration only, and 38222 covers both in the same session.
- Harvesting for transplant uses a different family of codes, 38230 and 38232.
- Pathology, flow cytometry, and imaging guidance are billed separately from the procedure.
- Understanding the composition and function of bone marrow helps coders recognize what the procedure note is describing.
- CPT codes are updated annually, so confirm against the current AMA code book and your payer’s policies.
Getting the code right keeps the focus where it belongs: on diagnosing and treating hematological disorders without administrative delays.
Frequently Asked Questions
What is the CPT code for a bone marrow biopsy with aspiration?
Use 38222 when both a core biopsy and an aspiration are performed through the same incision in the same session. It replaces reporting 38220 and 38221 separately for that site.
Can 38220 and 38221 be billed together?
Not for the same site in the same session, since 38222 exists for that combination. Separate reporting may be considered only for genuinely distinct sites, and payer rules on modifiers should be checked first.
Is decalcification billed separately?
Yes. Decalcification of the core is reported with 88311 in addition to the surgical pathology code. It is billed by the pathology service, not the proceduralist.
What code is used for collecting marrow from a donor?
Harvesting marrow for transplantation uses 38230 for allogeneic donation and 38232 for autologous collection. These are not diagnostic biopsy codes and should not be substituted for 38220 to 38222.
