CPT 88367Laboratory

Insitu hybridization auto

CPT 88367 covers automated in situ hybridization (ISH) testing, a laboratory technique that detects specific DNA or RNA sequences in tissue samples using computerized equipment. This test helps identify genetic abnormalities, infections, or cancer markers at the cellular level.

Showing rates for

National Average

Base Medicare rate

$105.77

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

0.73

PE RVU (NF)

2.51

MP RVU

0.03

Total RVU

3.27

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

NCCI bundling edits

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Billing tips

Bill one unit of 88367 per probe set or per slide prepared with automated ISH methodology, not per specimen received
Impact: Incorrect unit billing is the most common error; proper unit calculation can affect revenue by 30-50% when multiple probes are required
Document the specific automated imaging system used (brand and model) and the computerized analysis methodology in the pathology report
Impact: Distinguishes automated (88367) from manual (88365) ISH for audits; prevents $20-30 downcoding to manual methodology
Verify that the automated ISH is not bundled into other molecular pathology codes when billing comprehensive cancer panels
Impact: Prevents double billing; NCCI edits may bundle ISH into larger genomic panels, avoiding compliance violations
For Medicare patients, ensure medical necessity is documented with specific ICD-10 codes linking the ISH test to diagnosis or treatment decisions
Impact: Medicare LCD policies require documented medical necessity; missing documentation causes denials of the full $105.77 payment
When billing 88367 with 88360 (tumor immunofluorescence), append modifier 59 if both procedures are medically necessary and distinct
Impact: Prevents bundling denials; without modifier 59, payers may deny one service entirely, losing $105.77 in revenue
Separate billing for professional and technical components (26/TC modifiers) only when services are actually split between different entities
Impact: Improper modifier use triggers audits; correct split billing ensures accurate reimbursement allocation between hospital and pathologist

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 88367 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 88367 is $105.77 for both facility and non-facility settings. This rate is based on a total RVU of 3.27 multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 88367 and 88365?

CPT 88367 is for automated in situ hybridization using computerized imaging and analysis systems, while 88365 is for manual in situ hybridization requiring direct microscopic visualization by a pathologist. The automated method (88367) provides standardized, objective quantification, whereas manual (88365) relies on subjective interpretation.

How many units of 88367 can I bill for multiple probes?

Bill one unit of 88367 per probe set or per slide prepared with automated ISH methodology. If testing requires multiple distinct probe sets on different slides, multiple units may be appropriate with proper documentation and modifier 59 to indicate distinct procedural services.

Does CPT 88367 require a CLIA-certified laboratory?

Yes, CPT 88367 requires a CLIA-certified laboratory with high-complexity testing certification. Automated in situ hybridization is classified as high-complexity molecular testing requiring specialized equipment, personnel qualifications, and quality control procedures under CLIA regulations.

Can I bill 88367 with FISH codes like 88377?

Generally no, as FISH (fluorescence in situ hybridization) codes 88271-88275 and 88377 describe similar molecular cytogenetic techniques. Billing both ISH and FISH for the same specimen typically represents unbundling. Use the code that most accurately describes the specific methodology performed.

What are the Work RVUs for CPT code 88367?

CPT 88367 has 0.73 Work RVUs, 2.51 Practice Expense RVUs (both facility and non-facility), and 0.03 Malpractice RVUs, totaling 3.27 RVUs for 2025 according to the CMS Medicare Physician Fee Schedule.

Is prior authorization required for CPT 88367?

Prior authorization requirements vary by payer and geographic location. Many Medicare MACs and commercial payers require prior authorization for molecular pathology testing including automated ISH, particularly for cancer diagnosis. Always verify payer-specific requirements before performing the test to avoid denials.