CPT 88374Laboratory

M/phmtrc alys ishquant/semiq

CPT 88374 covers advanced laboratory analysis using computer-assisted morphometric techniques to analyze tissue samples, specifically for in situ hybridization testing that measures gene expression or chromosomal abnormalities in tissue.

Showing rates for

National Average

Base Medicare rate

$264.27

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

0.93

PE RVU (NF)

7.21

MP RVU

0.03

Total RVU

8.17

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

NCCI bundling edits

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Billing tips

Document the specific morphometric methodology used, including the computer-assisted imaging system, quantification algorithm, and whether analysis is quantitative (precise numerical values) or semi-quantitative (scoring ranges)
Impact: Prevents $264.27 denials for insufficient documentation; auditors specifically look for evidence that computer-assisted morphometric analysis was performed versus simple manual counting
Bill 88374 per specimen/slide analyzed, not per gene target, when multiple gene targets are evaluated on the same tissue section using the same morphometric analysis run
Impact: Prevents overbilling compliance issues; correct unit billing avoids recoupment of approximately $264.27 per incorrectly billed unit during audits
Verify that the ISH study being analyzed truly requires morphometric analysis; if simple visual interpretation without computer-assisted quantification is performed, code 88365 or 88367 is more appropriate
Impact: Using 88374 for non-morphometric ISH risks downcoding from $264.27 to lower-valued codes ($50-150 range), plus potential fraud flags
When performing both manual ISH interpretation and computer-assisted morphometric analysis on the same specimen, bill only 88374 as it represents the higher complexity service that includes the manual component
Impact: Prevents unbundling denials and potential recoupment; billing both codes could trigger $200+ in improper payments per case
Ensure pathologist documentation specifically mentions morphometric analysis results in the final pathology report, including numeric data or semi-quantitative scores generated by the computer system
Impact: Creates audit-proof documentation; absence of morphometric data in reports is the #1 reason for recoupment in post-payment audits

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 88374 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 88374 is $264.27 for both facility and non-facility settings. This rate is based on a total RVU of 8.17 (work RVU 0.93, non-facility PE RVU 7.21, MP RVU 0.03) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 88374 and 88377 for morphometric analysis?

CPT 88374 is used specifically for morphometric analysis of in situ hybridization (ISH) studies that are quantitative or semi-quantitative. CPT 88377 is used for morphometric analysis using immunohistochemistry (IHC). The key distinction is the underlying technique being analyzed: ISH (nucleic acid detection) uses 88374, while IHC (protein/antigen detection) uses 88377.

How many times can I bill CPT 88374 for the same patient on the same day?

You can bill 88374 multiple times on the same date if morphometric analysis is performed on different tissue specimens, different tissue blocks, or for different gene targets, each constituting a separate service. Use modifier 59 or XU to indicate distinct services and document medical necessity for each analysis. Billing multiple units for the same analysis on the same tissue is not appropriate.

Does CPT 88374 require a pathologist to perform the test?

The technical component can be performed by trained laboratory technologists in a CLIA-certified high-complexity laboratory, but the professional component (interpretation) must be performed or supervised by a qualified pathologist. The complete service represented by 88374 requires pathologist oversight and final interpretation in the pathology report.

What documentation is required to bill CPT 88374 to avoid audits?

Essential documentation includes: pathology report explicitly stating morphometric analysis was performed, identification of the computer-assisted imaging system used, specific quantitative data or semi-quantitative scores generated, the gene target analyzed, and pathologist interpretation of results. The report must demonstrate that computer-assisted quantification occurred, not just visual interpretation.

Can CPT 88374 be billed with tissue examination codes like 88305 or 88307?

Yes, 88374 can and typically should be billed in addition to the primary tissue examination code (88305-88309) as it represents the additional morphometric analysis of the ISH study performed on that specimen. These are separate services - the surgical pathology code covers tissue examination, while 88374 covers the specialized computer-assisted ISH analysis. Use appropriate modifiers if required by payer.

What are the RVU values for CPT code 88374 in 2025?

For 2025, CPT 88374 has a work RVU of 0.93, non-facility practice expense RVU of 7.21, facility practice expense RVU of 7.21, and malpractice RVU of 0.03, for a total RVU of 8.17. The high practice expense RVU reflects the significant cost of computer-assisted morphometric imaging equipment and specialized laboratory infrastructure required.