Under 2018 updates, two codes for reporting bone marrow services have changed significantly. Both the old codes and the updated versions are provided below.


  • 38220: Bone marrow, aspiration only
  • 38221: Bone marrow, biopsy, needle or trocar


  • 38220: Diagnostic bone marrow aspiration(s)
  • 38221: Diagnostic bone marrow biopsy(ies)

According to guidelines from the Centers for Medicare and Medicaid Services (CMS), neither of these codes should ever be reported alongside 38222, as 38222 covers both an aspiration and a biopsy of the marrow. In a similar vein, reporting 38220 and 38221 together is inappropriate because 38222 encompasses the procedures of both. The only exception is when the aspiration and the biopsy are performed at separate locations, in which case the updated version of the National Correct Coding Initiative (NCCI) Policy Manual states:

“The column one/column two code edit with column one CPT code 38221 (Diagnostic marrow biopsy) and column two CPT code 38220 (Diagnostic bone marrow, aspiration) includes two distinct procedures when performed at separate anatomic sites (e.g., contralateral iliac bones) or separate patient encounters. In these circumstances, it would be acceptable to use modifier 59. However, if both 38221 and 38220 are performed on the same iliac bone at the same patient encounter which is the usual practice, modifier 59 shall NOT be used. Although CMS does not allow separate payment for CPT code 38220 with CPT code 38221 when bone marrow aspiration and biopsy are performed on the same iliac bone at a single patient encounter, a physician may report CPT code 38222 (Diagnostic marrow; biopsy(ies) and aspiration(s)).”

In addition to these CPT changes, 2018 also brought about the demise of HCPCS code G0364 (Marrow aspiration performed with marrow biopsy through the same incision on the same date of service). Coders should be sure to omit this code from any future claims.