| Highmark Commercial Medical Policy in West Virginia |
| Section: | Miscellaneous |
| Number: | G-8 |
| Topic: | Bone Marrow Aspiration or Biopsy |
| Effective Date: | January 31, 2011 |
| Issued Date: | January 31, 2011 |
| Date Last Reviewed: |
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 may be made for the obtaining of multiple bone marrow biopsies (code 38221) on the same day when the biopsies are performed on different sites. Procedure code G0364 represents a bone marrow aspiration performed with a bone marrow biopsy through the same incision on the same date of service and should only be reported with procedure code 38221 - Bone marrow biopsy (obtaining). No payment will be made for code G0364 when reported independently. A participating, preferred, or network provider cannot bill the member separately for these services in this case. 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. |
| 38220 | 38221 | 85097 | 88305 | G0364 |
This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program |
| [Version 003 of G-8] |
| [Version 002 of G-8] |
| [Version 001 of G-8] |
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