Listed Codes for coverage
Each provider is legally responsible to ensure that all coding for reimbursement under federal reimbursement or commercial programs is recorded and submitted appropriately and within the legal and contractual parameters permissible for reimbursement or coverage of such services.
Vidacare is providing the information below to assist in this process, but disclaims any liability for the accuracy or appropriate use of such coding. In addition, the information below does not constitute legal or medical advice nor does Vidacare assume any liability for updating this information as new or different coding information becomes available.
Bone Marrow Aspiration and Biopsy; and Powered Bone Marrow Biopsy may be reported using the following HCPCS codes:
Bone Marrow, Aspiration only
CPT Code 38220
Bone Marrow, Biopsy, Needle or Trocar
CPT Code 38221
Bone Marrow Aspiration performed with Bone Marrow Biopsy through the
same incision at the same date of service
G0364 (Medicare use)
Power Bone Marrow Biopsy Needle
- Per Medicare guidelines, as outlined in the
National Correct Coding
Initiative Policy Manual, Chapter 5, Section E, when bone marrow aspiration
is performed alone, the appropriate code to report is CPT code 38220.
- When a
bone marrow biopsy is performed alone, the appropriate code to report is
Code 38221. CPT code 38221 cannot be reported with CPT code 20220
- CPT codes 38220 and 38221 may only be reported together if the two procedures
are performed at separate sites or at separate patient encounters. Separate
sites include bone marrow aspiration and biopsy in different bones or with two
separate skin incisions over the same bone.
- When a bone marrow biopsy (CPT code
38221) and bone marrow aspiration (CPT code 38220) are performed at the same
site through the same skin incision, report only CPT code 38221.
Use of CPT code modifier “59” (distinct procedural service) – Medicare
Use of CPT code modifier “59” appended to CPT codes 38220 and 38221 should
only be used if the two procedures are performed at separate sites or during
separate patient encounters. If the procedures occur through the same incision,
one should not use modifier “59” to report 38220 and 38221 together to Medicare.
For sequenced procedures through the same incision, HCPCS code G0364 should be
used. In this case, report CPT code 38221 for the biopsy as usual. The
aspiration should then be reported using HCPCS code G0364
(Bone marrow aspiration performed with bone marrow biopsy through the
same incision on the same date of service).
Coding with commercial insurers
Providers should contact their payer for specific coverage guidelines
before submitting claims for bone marrow aspiration and biopsy. Some commercial
and managed care payers may have guidelines that allow one to report 38220 and
38221 for sequenced procedures. Others may require you to report only the most
Coding for imaging services while performing a bone marrow biopsy and/or
According to the American College of Radiology, image guidance for all of
these procedures refers to the use of an imaging modality to identify the exact
location of the area to be treated or sampled. The imaging is also used to
ensure that the needle is placed in the correct location to obtain the biopsy.
For most drainage, aspiration, and biopsy procedures, the work and cost of
imaging is not included in the base code and should be reported separately.
Imaging for needle placement is paid in addition to the biopsy/aspiration
Biopsy and aspiration guidance can be performed with fluoroscopy,
ultrasound, or CT using the following CPT codes:
Fluoroscopic guidance for needle placement (e.g., biopsy,
aspiration, injection, localization device)
CPT Code 77002
Ultrasonic guidance for needle placement (e.g., biopsy,
aspiration, injection, localization device), imaging supervision and
CPT Code 76942
Computed tomography guidance for needle placement (e.g.,
biopsy, aspiration, injection, localization device), radiological supervision
CPT Code 77012
The choice of modality for imaging guidance depends on the site and
characteristics of the fluid collection or lesion. Whatever modality is
utilized, documentation of needle tip location in the physician notes is
necessary, according to the American College Radiology Practice Guidelines.