How much does Medicare pay for CPT 38221?

Medicare allowed an average of $117.32 per service and paid $91.31 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $719.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 38221?

Biopsy of bone marrow. It was billed 1,927 times to 1,816 Medicare beneficiaries by 96 providers in 2024.

Does 38221 pay differently in an office than a hospital?

Yes. The allowed amount averaged $155.13 in an office setting and $65.73 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 38221 most?

Hematology-Oncology, with 685 services from 33 clinicians. Next are Diagnostic Radiology, Nurse Practitioner, Physician Assistant.

CPT 38221

Biopsy of bone marrow

$117.32Medicare-allowed amount per service, averaged across 1,927 services

Providers submitted

$719.95

Asking price, not received

Medicare allowed

$117.32

The fee schedule figure

Medicare paid

$91.31

Balance is patient coinsurance

Providers submitted an average of $719.95 for this code and Medicare allowed $117.32 — 6.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $91.31 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $155.13
Hospital / facility: $65.73

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,112 services were billed in an office setting and 815 in a facility.

Services: 1,927
Beneficiaries: 1,816
Providers billing it: 96
Total allowed: $226,076

What Medicare pays for CPT 38221

Across 1,927 services billed by 96 providers to 1,816 beneficiaries, Medicare allowed an average of $117.32 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 38221

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	685	633	$164.14	33
Diagnostic Radiology	402	389	$82.00	22
Nurse Practitioner	220	206	$76.52	11
Physician Assistant	152	145	$64.54	6
Medical Oncology	147	138	$142.71	8
Hematology	133	124	$122.89	6
Interventional Radiology	103	99	$74.59	6
Pathology	58	55	$100.28	2
Internal Medicine	14	14	$162.94	1
Anesthesiology	13	13	$71.58	1

38221 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	387	$141.48	$98.34	18
New Jersey	326	$168.40	$119.42	12
New York	295	$110.17	$72.31	17
North Carolina	198	$61.92	$47.14	7
Florida	116	$102.64	$78.57	7
Texas	67	$63.11	$51.72	3
Virginia	63	$104.15	$83.33	3
Illinois	62	$65.29	$47.61	4
Wisconsin	61	$60.69	$47.63	3
Pennsylvania	47	$167.50	$117.54	3
Maryland	47	$169.09	$120.87	2
Massachusetts	44	$96.46	$65.00	3
Colorado	43	$66.74	$50.39	2
Louisiana	28	$63.87	$51.22	2
Arizona	19	$156.85	$126.92	1
Alabama	19	$152.61	$127.14	1
South Carolina	15	$67.94	$54.28	1
New Mexico	15	$70.74	$54.11	1
Washington	13	$68.31	$51.38	1
Ohio	13	$157.79	$110.66	1
Nevada	13	$66.85	$46.02	1
Missouri	13	$166.89	$127.35	1
District of Columbia	12	$71.67	$49.68	1
XX	11	$153.91	$110.16	1

Related codes

38222Biopsy and aspiration of bone marrow sample for diagnosis$96.05
38206Collection of stem cells for transplantation$73.22
38220Aspiration of bone marrow sample for diagnosis$69.39

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.