| |
| Section: |
Miscellaneous |
| Number: |
G-8 |
| Topic: |
Bone Marrow Aspiration or Biopsy |
| Effective Date: |
August 1, 2005 |
| Issued Date: |
September 10, 2007 |
| Date Last Reviewed: |
07/2007 |
General Policy Guidelines
Indications and Limitations of Coverage
Payment may be made for obtaining/interpretation of both a bone marrow aspiration and a bone marrow biopsy performed at the same time. However in accordance with multiple surgery guidelines, payment can be made for claims requesting the obtaining of multiple bone marrow biopsies (code 38221) on the same day only when the biopsies are performed on different sites.
The guidelines in the Table Attachment below apply to claims reporting bone marrow aspiration or biopsy services.
Description
A bone marrow biopsy (code 38221) is a complete section of marrow which can be obtained by needle or trochar but is not an aspirate smear. |
Procedure Codes
| 38220 | 38221 | 85097 | 88305 | G0364 | |
Traditional Guidelines
FEP Guidelines
PPO Guidelines
Managed Care POS Guidelines
Publications
References
View Previous Versions
Table Attachment
Bone Marrow Aspiration or Biopsy Services
|
If service reported is:
|
Code as:
|
| Bone marrow aspiration (obtaining) |
38220 |
| Bone marrow aspiration (interpretation) |
85097 |
| Bone marrow biopsy (obtaining) |
38221 |
| Bone marrow biopsy (interpretation) |
88305 |
|
Text Attachment
Procedure Code Attachments
Diagnosis Codes
Glossary
 |
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.
Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.
Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
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