CPT 88130 Fee Schedule
Healthcare 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 | Fluid washings, Hybridization and Sex Chromatin Identification Procedures Cytopathology Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 88130 |
National average reimbursement for CPT 88130 by major payers:
$18.60
$16.01
$18.95
$25.87
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 88130 | $10.79 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 88130 | $43.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 88130 | $43.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 88130 | $29.43 | 1053391094 - ASYA SEGALENE | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Allergy Physician (207KA0200X) |
United | 88130 | $39.56 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 88130 | $52.50 | 1326546797 - HENDERSON HOSPITAL, LLC, UTHEALTH EAST TEXAS HENDERSON HOSPITAL | 824019349 | TX | General Acute Care Hospital (282N00000X) |
United | 88130 | $25.89 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88130 | $23.30 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 88130 | $55.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 88130 | $21.57 | 1174526529 - TITUS COUNTY HOSPITAL DISTRICT, TITUS REGIONAL MEDICAL CENTER | 756003935 | TX | General Acute Care Hospital (282N00000X) |
United | 88130 | $15.27 | 1679557888 - CHRISTUS HEALTH SOUTHEAST TEXAS, CHRISTUS SOUTHEAST TEXAS - ST. ELIZABETH | 760591590 - (TX) CHRISTUS HEALTH SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 88130 | $27.19 | 1932729803 - DALLAS VAMC | 756108647 | TX | General Acute Care Hospital (282N00000X) |
United | 88130 | $23.30 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 88130 | $9.22 | 1689655912 - NOCONA HOSPITAL DISTRICT, NOCONA GENERAL HOSPITAL | 751368648 | TX | General Acute Care Hospital (282N00000X) |
United | 88130 | $25.89 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 88130 vs. Other Cytopathology Procedures Codes
The CPT 88130 code is part of the Fluid washings, Hybridization and Sex Chromatin Identification Procedures services used for Cytopathology 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 88130 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 |
|---|---|---|
| 88106-CPT | Low | Study Of Cells In Body Fluid, Cells Collected From Body Fluids Are Smeared Into A Thin Layer For Viewing Under A Microscope. The Study May Identify Signs Of Problems With Surgical Wounds And Certain Cancers. |
| 88108-CPT | Low | Laboratory Study Of Cells, Examination Of A Cell Sample Using Techniques To Identify If A Disease Is Present Or Not (Cytopathology). Results Are Interpreted For A Report. |
| 88112-CPT | Low | Advanced Lab Study Of Cells, Advanced Cytopathology (Cell) Study Of Complicated Cell Samples Using Substances To Enhance The Microscopic View For Better Detection Of Disease Type Or Comparison With Previous Studies. |
| 88130-CPT | Low | Genetic Test For Gender, The Test Is Done Most Frequently On Amniotic Fluid To Determine The Gender Of A Fetus. The Sample Is Examined For The Presence Of An Inactive X Chromosome Or Barr Body. Males Have A Y Chromosome Rather Than An Inactive X Chromosome. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88130 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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