CPT 88173Laboratory

Cytopath eval fna report

CPT 88173 covers the cytopathologist's professional work in examining and interpreting cells obtained from a fine needle aspiration (FNA) biopsy. This is the pathologist's written report that tells the ordering physician whether the cells appear normal, abnormal, or cancerous.

Showing rates for

National Average

Base Medicare rate

$166.26

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

Work RVU

1.39

PE RVU (NF)

3.69

MP RVU

0.06

Total RVU

5.14

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill 88173 only once per specimen site regardless of number of needle passes; multiple sites require multiple units with modifier 59
Impact: Prevents bundling denials and ensures appropriate reimbursement of $166.26 per distinct anatomic site
Distinguish from 88172 (initial FNA evaluation without report) - 88173 requires complete written report with diagnostic impression
Impact: 88173 yields $166.26 vs lower reimbursement for screening-only codes; documentation must support comprehensive interpretation
Link to appropriate ICD-10 codes indicating the specific mass or abnormality being evaluated, not just screening codes
Impact: Medical necessity documentation prevents denials; specific diagnosis codes support appropriate payment
Ensure pathology report includes specimen source, adequacy statement, cellular findings, and diagnostic interpretation
Impact: Complete documentation supports 1.39 work RVUs and reduces audit vulnerability
When billing for rapid on-site evaluation (88172) followed by final interpretation (88173), bill both codes if separately documented
Impact: Captures full scope of service; combined reimbursement exceeds $250 when both services documented
Verify LCD/NCD coverage policies for specific anatomic sites as some payers have frequency limitations for certain FNA locations
Impact: Proactive coverage verification prevents write-offs and ensures timely payment of full $166.26

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 88173 in 2025?

The 2025 Medicare national average payment for CPT 88173 is $166.26 for both facility and non-facility settings, with a total RVU of 5.14 and work RVU of 1.39.

Can CPT 88173 be billed multiple times on the same date of service?

Yes, CPT 88173 can be billed multiple times when FNA specimens are obtained from distinct anatomic sites (e.g., different thyroid nodules, separate lymph nodes). Each site requires separate documentation and typically requires modifier 59 to prevent bundling denials.

What is the difference between CPT 88172 and 88173?

CPT 88172 represents immediate cytopathologic evaluation and interpretation performed during the procedure (rapid on-site adequacy assessment), while 88173 is the formal comprehensive evaluation with written report performed after the procedure. Both may be billed for the same encounter if separately documented.

Does CPT 88173 include the technical component of the test?

CPT 88173 represents the professional component (pathologist interpretation). The specimen collection is reported separately with CPT codes in the 10000 series (e.g., 10021 for FNA without imaging). Technical preparation of slides is typically included in the professional service for cytopathology.

What documentation is required to bill CPT 88173?

Required documentation includes a formal pathology report with specimen source, adequacy statement, detailed cellular findings, diagnostic interpretation signed by a pathologist, and appropriate ICD-10 code linking to the clinical indication for the FNA.

Who can bill CPT 88173 - cytotechnologist or pathologist only?

Only a board-certified pathologist can bill CPT 88173. Cytotechnologists may perform preliminary screening, but the final interpretation and signed report must be completed by a qualified pathologist for compliant billing.

Can 88173 be billed with surgical pathology codes like 88305 or 88307?

Generally yes, if the FNA and surgical pathology represent separate encounters or distinct diagnostic services. If FNA is performed immediately before surgical excision at the same session, payers may bundle. Documentation should clearly establish medical necessity for both procedures and include modifier 59 when appropriate.