Cytp dx eval fna 1st ea site
CPT 88172 covers the laboratory evaluation of cells obtained from a fine needle aspiration (FNA) of the first site. A pathologist examines these cells under a microscope to diagnose diseases, particularly cancer.
This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Bill 88172 for the first site only; use 88173 for each additional site evaluated during the same session
Impact: Prevents underbilling; 88173 reimburses at similar rate ($54.67), adding significant revenue for multi-site evaluations
Verify that the FNA collection procedure (10021, 10004-10012) is billed separately by the performing physician, not bundled with 88172
Impact: 88172 covers only interpretation; the proceduralist bills separately for collection, avoiding revenue loss of $100-300 for the aspiration procedure
Document the specific anatomic site evaluated and ensure correlation with the requisition to support medical necessity
Impact: Reduces denial risk by 30-40%; site-specific documentation is required for audit defense and prevents downcoding
Do not bill 88172 with 88177 (immediate cytopath evaluation) for the same specimen unless separate, distinct evaluations are performed
Impact: Prevents NCCI edits and bundling denials; 88177 is for rapid on-site evaluation, while 88172 is for final interpretation
Ensure diagnosis codes reflect the indication for FNA and findings, using appropriate ICD-10 codes for mass, nodule, or abnormal imaging
Impact: Improves clean claim rate by 20-25%; vague diagnosis codes trigger medical necessity denials
Bill on the date of final interpretation and report signature, not the date of specimen collection
Impact: Ensures compliance with CMS guidelines; incorrect dating can delay payment by 7-14 days or trigger audit
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