Mountain State Medical Policy Bulletin
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

38220382218509788305G0364 

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

View Previous Versions

[Version 001 of G-8]

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.