Hematology CPT Reference

Hematology CPT Codes and Reimbursement Rates

Hematology billing uses CPT codes spanning diagnostic evaluations, bone marrow procedures (38220-38222), and the administration of complex drug therapies for blood disorders.

Get Your Free Assessment Explore the Guide
Hematology CPT Codes and Reimbursement Rates
01

Always use 38222 (combined biopsy + aspiration, ~$280-$380) instead of billing 38220 and 38221 separately

02

Chemotherapy infusion hierarchy: 96413 (first hour) then 96415 (additional hours) then 96417 (second drug)

03

Drug buy-and-bill margin can represent 30-50% of total hematology practice revenue

04

Transfusion (36430) billing rules vary by payer: per unit vs. per session. Verify before billing.

Overview

Why Hematology CPT Codes Teams Need a Better Workflow

Hematology billing uses CPT codes spanning diagnostic evaluations, bone marrow procedures (38220-38222), and the administration of complex drug therapies for blood disorders. The specialty combines office-based consultations with laboratory interpretation and infusion services, creating a billing profile that crosses multiple coding categories simultaneously.

This reference covers the CPT codes most commonly billed in hematology practices across clinical settings. Sections address bone marrow biopsy and aspiration coding, blood product administration, drug infusion and chemotherapy services, and the E/M codes used for initial and follow-up hematological consultations.

Why Hematology CPT Codes Teams Need a Better Workflow
Challenges

Common Hematology CPT Codes Challenges We Solve

Every Hematology CPT Codes team deals with payer delays, coding nuance, and collection leakage.

Always use 38222 (combined biopsy + aspiration, ~$280-$380) instead of billing 38220 and 38221 separately

The workflow has to support this issue before claim submission, or it turns into avoidable rework after the payer responds.

Chemotherapy infusion hierarchy: 96413 (first hour) then 96415 (additional hours) then 96417 (second drug)

When this area is inconsistent, denial rate, payment timing, and staff follow-up effort all get worse at the same time.

Drug buy-and-bill margin can represent 30-50% of total hematology practice revenue

Tight documentation and coding controls here usually improve both reimbursement accuracy and operational speed.

Transfusion (36430) billing rules vary by payer: per unit vs. per session. Verify before billing.

This is one of the first places revenue leakage shows up when specialty billing habits are not standardized.

Services

Complete Hematology CPT Codes Resources

Support spans the full revenue cycle.

Billing Process

Claim Denials

Revenue Cycle

Outsourcing

Coding Guide

Hematology Billing Hub

Coverage

Serving Hematology Billing Teams Nationwide

We support independent practices and growing provider organizations.

Hematology private practices

Hematology multisite groups

Hematology billing managers

Hematology owners and operators

Guide

The Complete Guide to Hematology CPT Codes

Hematology CPT Code Framework

Hematology billing involves a unique combination of cognitive E/M services, diagnostic procedures, and drug administration services. Unlike most medical specialties where E/M visits dominate the revenue mix, hematology practices derive a substantial portion of revenue from chemotherapy administration, infusion services, and drug buy-and-bill arrangements. The CPT code structure for hematology spans office visits (99202-99215), bone marrow procedures (38220-38222), chemotherapy administration (96401-96417), non-chemotherapy infusion (96365-96375), and therapeutic phlebotomy (99195). Understanding both the procedural codes and the drug administration hierarchy is essential because the administration codes generate revenue independently of the drug itself.

The financial model for many hematology practices includes drug margin (the difference between the acquisition cost of chemotherapy and biologic agents and the reimbursement from payers), which can represent 30% to 50% of total practice revenue. This “buy-and-bill” model means that accurate drug administration coding directly affects both the administration fee revenue and the drug reimbursement revenue. Undercoding administration services reduces revenue twice: once on the administration fee and once on the drug payment if the claim is denied or reduced.

Bone Marrow Biopsy and Aspiration Codes (38220-38222)

Code 38220 (bone marrow aspiration only, approximately $150 to $200) covers diagnostic aspiration without core biopsy. Code 38221 (bone marrow biopsy only, approximately $200 to $280) covers core biopsy without aspiration. Code 38222 (bone marrow biopsy and aspiration, approximately $280 to $380) covers the combined procedure, which is the standard of care for most diagnostic bone marrow evaluations. The combined code (38222) reimburses at a rate lower than the sum of the individual codes (38220 + 38221) because it bundles the two procedures into a single service. When both aspiration and biopsy are performed, always use 38222 rather than billing 38220 and 38221 separately, which would be an unbundling violation.

Chemotherapy Administration Codes (96401-96417)

Chemotherapy administration codes are organized by route and timing. Code 96401 (subcutaneous or intramuscular chemotherapy, approximately $60 to $80) covers injections of chemotherapy agents. Code 96409 (IV push chemotherapy, single or initial substance, approximately $140 to $180) is the initial IV push code. Code 96411 (IV push, each additional substance, approximately $65 to $85) is the add-on code for additional IV push agents. Code 96413 (chemotherapy infusion, first hour, approximately $180 to $250) covers the initial hour of IV chemotherapy infusion. Code 96415 (chemotherapy infusion, each additional hour, approximately $55 to $75) adds time beyond the first hour. Code 96417 (chemotherapy infusion, each additional sequential infusion of a new substance, up to 1 hour, approximately $130 to $170) covers the second and subsequent different chemotherapy drugs infused sequentially.

The chemotherapy administration hierarchy determines coding when multiple agents are administered in one session. The first drug infused uses the initial infusion code (96413). If the infusion exceeds one hour, add 96415 for each additional hour. If a second chemotherapy drug is infused sequentially, use 96417 for the first hour of the second drug. If a drug is pushed IV rather than infused, use 96409 for the first push and 96411 for additional pushes. This hierarchy must be followed in order; skipping levels or using the wrong code for the administration sequence results in denials.

Non-Chemotherapy Infusion Codes (96365-96368)

Non-chemotherapy infusion codes cover drugs that are not antineoplastic agents: iron infusions (ferric carboxymaltose, iron sucrose), immunoglobulin (IVIG), biologic agents for autoimmune hematologic conditions, and supportive care drugs. Code 96365 (IV infusion, therapeutic, first hour, approximately $130 to $170) is the initial hour of non-chemotherapy infusion. Code 96366 (each additional hour, approximately $35 to $50) extends beyond the first hour. Code 96367 (additional sequential infusion of a new substance, approximately $75 to $100) covers the second drug infused. Code 96368 (concurrent infusion, approximately $50 to $70) covers a drug infused simultaneously with another drug through a separate line. These codes pay less than chemotherapy administration codes but are used frequently for supportive care in hematology.

Transfusion Code (36430)

Code 36430 (transfusion of blood or blood components, approximately $120 to $160) covers the administration of packed red blood cells, platelets, fresh frozen plasma, or cryoprecipitate. This code is reported per transfusion episode regardless of the number of units transfused. Some payers allow one 36430 per unit transfused; others allow one per session. Verify payer-specific rules because overbilling (one code per unit when the payer allows only one per session) creates audit risk, while underbilling (one code per session when the payer allows one per unit) leaves revenue on the table. Factor VIII and other clotting factor administration uses different codes (96365 for the infusion plus the appropriate J-code for the product).

Common Hematology CPT Codes

CPT Code Description Reimbursement Range
38222 Bone marrow biopsy and aspiration $280 - $380
96413 Chemotherapy infusion, first hour $180 - $250
96409 IV push chemotherapy, initial substance $140 - $180
96365 Non-chemo therapeutic infusion, first hour $130 - $170
36430 Blood transfusion $120 - $160
96417 Chemo infusion, additional sequential substance $130 - $170
Common Questions

Hematology CPT Codes FAQ

Answers to the questions practice owners ask most often.

The hierarchy determines which code to assign when multiple drugs are given in one session. The first drug infused uses the primary infusion code (96413 for the first hour). Additional hours of the same drug use 96415. When a second chemotherapy drug is infused after the first, use 96417 (additional sequential infusion). IV push drugs use 96409 for the first push and 96411 for each additional push. Hydration (96360-96361) is the lowest in the hierarchy and is only coded when it is the sole service or when it runs for at least 31 minutes independently of chemotherapy. Always start coding with the highest-hierarchy service.

No. When both aspiration and biopsy are performed at the same site during the same session, use the combined code 38222. Billing 38220 and 38221 separately is considered unbundling and creates compliance risk. The only time you would bill 38220 or 38221 individually is when only the aspiration or only the biopsy was performed (which is clinically unusual for a diagnostic bone marrow evaluation). If aspiration and biopsy are performed at two different anatomic sites in the same session, you may bill 38222 for the first site and the appropriate code with modifier 59 for the second site, though this scenario is rare.

Hydration (96360 for the first hour, 96361 for each additional hour) can only be billed when it runs for at least 31 minutes independently of chemotherapy administration. Pre-chemotherapy hydration that runs for 45 minutes qualifies for 96360. A 15-minute saline flush between chemotherapy drugs does not qualify because it does not meet the 31-minute threshold. Hydration is the lowest code in the administration hierarchy, so it is coded last. If the total hydration time (excluding time concurrent with chemotherapy) is less than 31 minutes, it cannot be billed. Document hydration start and stop times separately from chemotherapy infusion times.

Code 96413 is for chemotherapy (antineoplastic) drug infusion. Code 96365 is for non-chemotherapy therapeutic drug infusion (iron, IVIG, rituximab for non-oncologic indications, and other biologic agents). The clinical difference is whether the drug being infused is classified as an antineoplastic agent. Rituximab infused for lymphoma uses 96413; rituximab infused for rheumatoid arthritis uses 96365. The distinction matters because chemotherapy administration codes reimburse higher than non-chemotherapy codes and have different add-on code structures (96415/96417 vs 96366/96367).

READY TO GET STARTED?

Start Billing Smarter for Hematology CPT Codes

Get a revenue review and a clear action plan tailored to your practice.

Get Your Free Assessment

HIPAA Compliant · No Upfront Fees · No Long-Term Contracts