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See a sample rate comparisonCPT 88130 Fee Schedule
Last Verified: September 2026
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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory 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 |
| Medicaid Fee Schedule | View Medicaid rates for 88130 |
National average reimbursement for CPT 88130 by major payers:
$18.60
$16.01
$18.95
$25.87
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CPT 88130
5 of 25 sample ratesHigher to lower in this preview
Da Pediatric Rehabilitation
$55.00Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$43.40Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$25.89Published rateChildrens National Medical Center
Childrens Hospital
$17.98Published rateNocona Hospital District, Nocona General Hospital
$9.22Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 88130 vs. Other Cytopathology Procedures Codes
The CPT 88130 code is part of the Pathology and Laboratory 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 |
|---|---|---|
| 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. |
| 88125-CPT | Low | Lab Testing Related To A Crime, Material From A Body Such As Hair Skin Or Blood Is Collected From A Crime Scene And Tested In A Laboratory. The Purpose Is To Identify Or Exclude A Persons Involvement In The Crime. |
| 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. |
| 88140-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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