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See a sample rate comparisonHealthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Anatomic Pathology Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | QW - CLIA Waived Tests None 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 88040 |
National average reimbursement for CPT 88040 by major payers:

$652.88

$470.92

$630.79

$645.97
Choose a payer to see a sample of rates for CPT 88040.
Mercy Medical Center
St Joseph Hospital
Progressive Medical Center, S.C.
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
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Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 88040 vs. Other Anatomic Pathology Procedures Codes
The CPT 88040 code is part of the Pathology and Laboratory Procedures services used for Anatomic Pathology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 88040 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 88025-CPT | Moderate | Full Autopsy Of Body And Brain, Autopsy Is An Examination Of A Deceased Persons Body To Determine Cause Of Death. A Full Autopsy Examines The Exterior And Interior Of The Body And The Brain With The Naked Eye And With A Microscope. |
| 88037-CPT | Low | Necropsy (Autopsy) Lmtd Gross &/Or Microscop; Sngle Organ, Necropsy (Autopsy) Limited Gross And/Or Microscopic; Single Organ |
| 88040-CPT | Moderate | Autopsy Related To A Crime, Exam Of A Person To Determine The Cause Of Death. This Type Of Autopsy Is Performed In The Context Of A Crime Investigation. |
| 88045-CPT | Low | Coroners Autopsy, A Coroners Autopsy Is An Examination Of The Body After Death To Determine The Unnatural Cause Of Death. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88040 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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