Medicare Payment for Pathology Services, 2015
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 […]
| 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 report | $31.17 | $31.86 | 2.2% |
| 88300 | Surgical path gross | $14.69 | $15.39 | 4.8% |
| 88302 | Tissue exam by pathologist | $30.09 | $32.22 | 7.1% |
| 88304 | Tissue exam by pathologist | $43.35 | $45.83 | 5.7% |
| 88305 | Tissue exam by pathologist | $70.57 | $73.03 | 3.5% |
| 88307 | Tissue exam by pathologist | $288.37 | $307.18 | 6.5% |
| 88309 | Tissue exam by pathologist | $438.83 | $465.06 | 6.0% |
| 88312 | Special stains group 1 | $94.57 | $97.74 | 3.3% |
| 88313 | Special stains group 2 | $65.91 | $68.02 | 3.2% |
| 88314 | Histochemical stains add-on | $78.09 | $74.82 | -4.2% |
| 88329 | Path consult intraop | $57.32 | $59.07 | 3.1% |
| 88331 | Path consult intraop 1 bloc | $98.87 | $103.11 | 4.3% |
| 88332 | Path consult intraop addl | $43.70 | $45.47 | 4.0% |
| 88333 | Intraop cyto path consult 1 | $104.60 | $109.55 | 4.7% |
| 88334 | Intraop cyto path consult 2 | $65.20 | $66.95 | 2.7% |
| 88341* | Immunohisto antibody slide | $0.00 | $67.31 | N/A |
| 88342* | Immunohisto antibody stain | $0.00 | $90.58 | N/A |
| 88344* | Immunohisto antibody slide | N/A | $117.07 | N/A |
| 88346 | Immunofluorescent study | $106.39 | $110.27 | 3.6% |
| 88347 | Immunofluorescent study | $88.84 | $93.08 | 4.8% |
| 88348 | Electron microscopy | $702.49 | $210.51 | -70.0% |
| 88356 | Analysis 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% |
| 88377 | M/phmtrc analysis quant/semiq | N/A | $214.45 | N/A |
| 88380 | Microdissection laser | $190.58 | $132.82 | -30.3% |
| 88381 | Microdissection manual | $160.84 | $124.59 | -22.5% |
| 88387 | Tiss exam molecular study | $35.82 | $42.96 | 19.9% |
| G0416 | Prostate 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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