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Medicare Payment for Pathology Services, 2015

by | Feb 25, 2015 | CMS-nir, Essential, National Lab Reporter

MEDICARE PAYMENT FOR PATHOLOGY SERVICES, 2015 (PARTIAL LISTING OF PATHOLOGY CODES) *Please note that there is not a direct crosswalk between payment for in situ hybridization and immunohistochemisty services as the codes and reporting have changed for 2015. The College of American Pathologists worked for these changes in 2015 to address payment and reporting limitations sought from the Centers for Medicare and Medicaid Services as both code families were targeted by the agency as overvalued. For example, in 2014 CMS payment policies reduced the reporting of CPT code 88368 to one unit of service. In 2015 one unit of the new multiplex code (88377) would be reported. HCPCS DESCRIPTION1 2014 TOTAL PAYMENT2 2015 TOTAL PAYMENT3 TOTAL PAYMENT PERCENT CHANGE 80500 Lab pathology consultation $21.14 $23.27 10.1% 80500 Lab pathology consultation $21.14 $23.27 10.1% 80502 Lab pathology consultation $68.42 $73.39 7.3% 88120 Cytp urine 3-5 probes ea spec $618.66 $625.09 1.0% 88121 Cytp urine 3-5 probes cmptr $535.19 $555.64 3.8% 88125 Forensic cytopathology $22.21 $26.49 19.3% 88184 Flowcytometry/tc 1 marker $87.77 $93.80 6.9% 88185 Flowcytometry/tc add-on $53.73 $56.92 5.9% 88187 Flowcytometry/read 2-8 $71.65 $72.32 0.9% 88188 Flowcytometry/read 9-15 $90.27 $91.65 1.5% 88189 Flowcytometry/read 16 or more $110.69 $113.13 2.2% 88291 Cyto/molecular […]

MEDICARE PAYMENT FOR PATHOLOGY SERVICES, 2015 (PARTIAL LISTING OF PATHOLOGY CODES)
*Please note that there is not a direct crosswalk between payment for in situ hybridization and immunohistochemisty services as the codes and reporting have changed for 2015. The College of American Pathologists worked for these changes in 2015 to address payment and reporting limitations sought from the Centers for Medicare and Medicaid Services as both code families were targeted by the agency as overvalued. For example, in 2014 CMS payment policies reduced the reporting of CPT code 88368 to one unit of service. In 2015 one unit of the new multiplex code (88377) would be reported.
HCPCSDESCRIPTION1 2014 TOTAL PAYMENT2 2015 TOTAL PAYMENT3 TOTAL PAYMENT PERCENT CHANGE
80500Lab pathology consultation$21.14$23.2710.1%
80500Lab pathology consultation$21.14$23.2710.1%
80502Lab pathology consultation$68.42$73.397.3%
88120Cytp urine 3-5 probes ea spec$618.66$625.091.0%
88121Cytp urine 3-5 probes cmptr$535.19$555.643.8%
88125Forensic cytopathology$22.21$26.4919.3%
88184Flowcytometry/tc 1 marker$87.77$93.806.9%
88185Flowcytometry/tc add-on$53.73$56.925.9%
88187Flowcytometry/read 2-8$71.65$72.320.9%
88188Flowcytometry/read 9-15$90.27$91.651.5%
88189Flowcytometry/read 16 or more$110.69$113.132.2%
88291Cyto/molecular report$31.17$31.862.2%
88300Surgical path gross$14.69$15.394.8%
88302Tissue exam by pathologist$30.09$32.227.1%
88304Tissue exam by pathologist$43.35$45.835.7%
88305Tissue exam by pathologist$70.57$73.033.5%
88307Tissue exam by pathologist$288.37$307.186.5%
88309Tissue exam by pathologist$438.83$465.066.0%
88312Special stains group 1$94.57$97.743.3%
88313Special stains group 2$65.91$68.023.2%
88314Histochemical stains add-on$78.09$74.82-4.2%
88329Path consult intraop$57.32$59.073.1%
88331Path consult intraop 1 bloc$98.87$103.114.3%
88332Path consult intraop addl$43.70$45.474.0%
88333Intraop cyto path consult 1$104.60$109.554.7%
88334Intraop cyto path consult 2$65.20$66.952.7%
88341*Immunohisto antibody slide$0.00$67.31N/A
88342*Immunohisto antibody stain$0.00$90.58N/A
88344*Immunohisto antibody slideN/A$117.07N/A
88346Immunofluorescent study$106.39$110.273.6%
88347Immunofluorescent study$88.84$93.084.8%
88348Electron microscopy$702.49$210.51-70.0%
88356Analysis nerve$279.78$205.86-26.4%
88365*In situ hybridization (FISH)$177.32$157.17-11.4%
88367*In situ hybridization auto$255.77$107.40-58.0%
88368*In situ hybridization manual$232.49$108.84-53.2%
88377M/phmtrc analysis quant/semiqN/A$214.45N/A
88380Microdissection laser$190.58$132.82-30.3%
88381Microdissection manual$160.84$124.59-22.5%
88387Tiss exam molecular study$35.82$42.9619.9%
G0416Prostate biopsy, any mthd$651.26$648.72-0.4%
  1. CPT codes and descriptions are copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2. Payments based on the 2014 conversion factor of 35.8228. 3. Payments based on the 2014 conversion factor of 35.8228, adjusted to 35.8013 to include the budget neutrality adjustment. Source: College of American Pathologists

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