CPT 88325Laboratory

Consltj compre rvw rec reprt

CPT code 88325 covers a comprehensive pathology consultation where a specialist reviews tissue slides, reports, and records from another pathologist to provide a second expert opinion on a diagnosis.

Showing rates for

National Average

Base Medicare rate

$152.03

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

2.85

PE RVU (NF)

1.72

MP RVU

0.13

Total RVU

4.7

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

NCCI bundling edits

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Billing tips

Document all materials reviewed including number of slides, blocks examined, reports reviewed, and clinical records consulted to support comprehensive nature
Impact: Prevents downcoding to 88321 (limited consultation) which pays $86.61 less ($152.03 vs $65.42)
Ensure the consultation report clearly indicates this is a second opinion review with new interpretation, not merely confirmation of original diagnosis
Impact: Reduces denial rate by 40-50% for lack of medical necessity when distinct value-added opinion is documented
Bill on the date the final consultation report is signed and issued, not the date materials were received
Impact: Ensures proper date of service for timely filing and matches Medicare's interpretation standard
Do not bill 88325 in conjunction with primary specimen interpretation codes (88302-88309) for the same specimen
Impact: Prevents bundling denials and potential fraud allegations; 88325 is for second opinions only
Verify that the requesting physician documented medical necessity for the consultation in the patient's medical record
Impact: Supports medical necessity during audits; lack of documented request is top reason for retrospective denials
For Medicare patients, confirm the consultation meets LCD/NCD criteria for pathology second opinions in your MAC jurisdiction
Impact: Prevents denials in jurisdictions with specific coverage limitations; some MACs require specific diagnoses or circumstances

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Frequently asked questions

What is the difference between CPT 88325 and 88323 for pathology consultations?

CPT 88325 is for comprehensive consultations requiring review of records and material sent by the patient or another pathologist, while 88323 is for consultation during surgery with frozen section and/or cytologic evaluation. 88325 is retrospective second opinion work; 88323 is intraoperative immediate guidance. The 2025 Medicare rate for 88325 is $152.03 compared to varying rates for 88323 depending on tissue blocks examined.

How much does Medicare pay for CPT code 88325 in 2025?

Medicare pays $152.03 for CPT 88325 under the 2025 non-facility rate (national average) and $128.74 for the facility rate. The code has 4.7 total RVUs (2.85 work RVU, 1.72 non-facility PE RVU, 0.13 MP RVU) using the 2025 conversion factor of 32.3465.

Can CPT 88325 be billed with modifier 26 for professional component only?

Yes, modifier 26 can be appended to 88325 when billing only the professional component (pathologist's interpretation) separately from the technical component. This is appropriate when the technical resources are provided by a different entity or in split billing arrangements between pathologists and facilities.

What documentation is required to bill CPT 88325 without denials?

Required documentation includes: identification of all materials reviewed (slides, blocks, reports), number of specimens examined, the requesting physician's consultation request with clinical indication, independent diagnostic interpretation, comparison with original diagnosis, and a detailed report demonstrating comprehensive review beyond simple confirmation of the original pathology findings.

When should I use 88325 versus 88321 for pathology consultation?

Use 88325 for comprehensive consultations requiring extensive review of slides, blocks, reports, and clinical records with detailed interpretation. Use 88321 for limited consultations requiring review of materials without full comprehensive analysis. The distinction impacts payment: 88325 pays $152.03 versus significantly less for 88321, so documentation must support the comprehensive nature.

Can I bill both 88325 and a primary surgical pathology code for the same specimen?

No, CPT 88325 should not be billed with primary specimen interpretation codes (88302-88309) for the same specimen. 88325 is exclusively for second opinion consultations on material already interpreted by another pathologist. Billing both constitutes improper unbundling and can trigger fraud investigations.

What are the most common denial reasons for CPT code 88325?

The most common denials for 88325 are: (1) lack of documented medical necessity for the consultation, (2) insufficient documentation of comprehensive review leading to downcoding to 88321, (3) duplicate billing concerns when billed alongside primary interpretation codes, and (4) missing prior authorization or formal consultation request from the referring physician.