CPT
31231 — Nasal endoscopy, diagnostic, unilateral or bilateral
Verify the code matches the actual service and dose.
Surgery & procedures
38221 — Bone marrow biopsy, needle; first sampling
This code covers a bone marrow biopsy — a procedure in which a doctor inserts a special needle into a large bone (usually the hip/pelvis) to remove a core of bone marrow tissue for laboratory examination.
- Typical setting: Hospital OR, ASC
- National avg charge (illustrative): $180-$350 Medicare allowed (approx. $200-$290 national Medicare average; commercial payers $300-$500+)
- Most-disputed reason: Billing aspiration and biopsy separately without proper codes: when both a bone marrow aspiration (38220) and biopsy (38221) are performed at the same session, specific coding rules apply — they may or may not both be separately payable depending on payer
What it means
What 38221 actually means
This code covers a bone marrow biopsy — a procedure in which a doctor inserts a special needle into a large bone (usually the hip/pelvis) to remove a core of bone marrow tissue for laboratory examination. It is used to diagnose blood cancers, anemia, and other blood disorders. The marrow sample is sent to a pathologist for analysis (billed separately).
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing aspiration and biopsy separately without proper codes: when both a bone marrow aspiration (38220) and biopsy (38221) are performed at the same session, specific coding rules apply — they may or may not both be separately payable depending on payer
- Pathology unbundling: the biopsy fee (38221) does not include the pathology interpretation (88305-88307) — these are legitimately separate bills from different providers
- Facility vs. physician billing: both the hospital and the physician may bill for this procedure but for different components — patients receiving two separate bills is expected and not a duplicate
If you see 38221 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 38221 often also see these adjacent codes on the same bill.
CPT
31237 — Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement
Verify the code matches the actual service and dose.
CPT
36415 — Routine venipuncture for collection of specimen
Verify the code matches the actual service and dose.
CPT
36416 — Collection of capillary blood specimen, finger, heel, or ear stick
Verify the code matches the actual service and dose.
Related BillBusted guides
Plain-English reads if you see 38221 on a bill.
38221 FAQ
Plain-English answers.
What does 38221 usually cost?
$180-$350 Medicare allowed (approx. $200-$290 national Medicare average; commercial payers $300-$500+). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 38221?
Billing aspiration and biopsy separately without proper codes: when both a bone marrow aspiration (38220) and biopsy (38221) are performed at the same session, specific coding rules apply — they may or may not both be separately payable depending on payer
What should I do if I see 38221 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 38221 before paying.
Don't pay 38221 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.