CPT 88307Laboratory

Tissue exam by pathologist

CPT 88307 covers the pathologist's examination of tissue samples removed during biopsies or surgeries. This is a comprehensive evaluation of moderately complex tissue specimens to diagnose disease, including cancers.

Showing rates for

National Average

Base Medicare rate

$278.18

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

1.59

PE RVU (NF)

6.94

MP RVU

0.07

Total RVU

8.6

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

NCCI bundling edits

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Billing tips

Bill one unit of 88307 per specimen, not per block or slide. Each distinct tissue site or lesion removed separately constitutes one specimen.
Impact: Proper specimen counting can increase revenue by 15-30% when multiple distinct anatomic sites are biopsied in same session
Verify specimen complexity matches Level V criteria. Breast re-excisions (88307) vs simple mastectomy specimens (88307) vs radical mastectomy (88309) require different codes.
Impact: Coding too low costs $60-150 per specimen; coding too high triggers audits with potential recoupment of $278.18 per occurrence
Document each specimen container separately with unique anatomic site identification. Use modifier 59 when billing multiple units from truly distinct sites.
Impact: Missing modifier 59 results in 50% payment reduction on second and subsequent units under NCCI edits
For physician practices sending specimens to reference labs, ensure contractual agreements clarify TC/26 split to avoid duplicate billing.
Impact: Prevents claim denials and potential fraud allegations; protects the full $278.18 reimbursement from coordination of benefits issues
Include specific diagnostic findings and tumor characteristics (size, margins, grade) in pathology reports to support medical necessity and prevent downcoding.
Impact: Detailed documentation reduces payer audits by 40% and supports level of service when appealing denials
Bill 88307 on the date the pathologist completes interpretation, not specimen collection date, especially for Medicare beneficiaries.
Correct date of service prevents timely filing denials and ensures proper coordination with global surgical periods

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 88307 in 2025?

The 2025 Medicare national average reimbursement for CPT 88307 is $278.18 for both facility and non-facility settings. This rate is based on 8.6 total RVUs (1.59 work RVU, 6.94 PE RVU, 0.07 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

How many times can you bill CPT 88307 on the same day?

You can bill 88307 multiple times on the same day when examining specimens from distinct anatomic sites collected in separate containers. Each separately identified specimen meeting Level V criteria is billable as one unit. Use modifier 59 on subsequent units to indicate distinct procedural services and prevent bundling denials.

What is the difference between CPT 88305 and 88307?

CPT 88305 (Level IV) covers less complex specimens like skin tags, simple cysts, or hemorrhoids, while 88307 (Level V) involves moderately complex specimens requiring more extensive pathologist interpretation, such as breast biopsies, prostate needle biopsies, and malignant skin lesions. The complexity difference results in $278.18 reimbursement for 88307 versus approximately $92 for 88305.

Does CPT 88307 include immunohistochemistry stains?

No, CPT 88307 covers only routine H&E staining and standard microscopic examination. Special stains and immunohistochemistry are billed separately using codes 88342 (immunohistochemistry per antibody) or 88313 (special histochemical stains). These ancillary studies are commonly performed with 88307 to clarify diagnosis.

Can you bill 88307 with modifier 26 for interpretation only?

Yes, modifier 26 is appropriate when the pathologist provides only professional interpretation of slides prepared at another facility. The facility performing technical processing bills with modifier TC. However, most integrated pathology laboratories bill 88307 globally without modifiers when performing both technical and professional components.

What specimens qualify for CPT 88307 Level V surgical pathology?

Common 88307 specimens include breast biopsy (not requiring re-excision), prostate needle biopsy (any method), bone marrow biopsy, colon polyps, skin lesions other than tag/cyst, soft tissue tumors, uterine curettings, and artery biopsy. The CPT manual provides a complete list, but specimens must demonstrate moderate complexity requiring detailed pathologist evaluation.

How do you appeal an 88307 denial for medical necessity?

Submit a comprehensive appeal including the pathology report, clinical notes documenting indication for biopsy (abnormal exam, imaging findings, symptoms), relevant diagnosis codes, and physician statement of medical necessity. Reference the specific clinical findings that prompted tissue examination and explain how results impacted patient management. Include peer-reviewed guidelines supporting biopsy indication when available.