CPT 88155 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 | • Pathology and Laboratory Procedures • Cytopathology Procedures |
| Common Place of Service | • 11 - Office • 81 - Independent Laboratory • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • QW - CLIA Waived Tests • 99 - Multiple Modifiers |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 88155 |
National average reimbursement for CPT 88155 by major payers:
$12.87
$9.79
$12.61
$20.87
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 88155 | ||||||
United | 88155 | $18.99 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88155 | $17.58 | 1366428401 - AARON ASKEW | 931224010 - PRAXIS HEALTH, P.C. | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 88155 | $10.10 | 1235122029 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 88155 | $13.18 | 1407301211 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH OB/GYN CLINIC | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 88155 | $40.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 88155 | $13.18 | 1841746948 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-GREER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 88155 | $5.00 | 1457358103 - BELLVILLE HOSPITAL DISTRICT, BELLVILLE GENERAL HOSPITAL | 760636528 | TX | General Acute Care Hospital (282N00000X) |
United | 88155 | $13.19 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88155 | $11.41 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88155 | $21.10 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88155 | $10.10 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 88155 | $35.37 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 88155 | $5.26 | 1568848059 - CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC, LEGENT ORTHOPEDIC & SPINE | 474612520 | TX | General Acute Care Hospital (282N00000X) |
United | 88155 | $13.18 | 1255367637 - OCONEE MEDICAL CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 88155 | $8.79 | 1003166612 - MATTHEW LILLEY | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Surgery Physician (207X00000X) |
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 88155 vs. Other Cytopathology Procedures Codes
The CPT 88155 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 88155 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 |
|---|---|---|
| 88150-CPT | Low | Cytopathology, Smears, Cervical Or Vaginal (Eg, Papanicolaou), Up To Three Smears; Screening By Technician Under Phys |
| 88152-CPT | Low | Cytopathology, Slides, Cervical Or Vaginal; With Manual Screening And Computer-Assisted Rescreening Under Physician Supervision |
| 88153-CPT | Low | Cytopathology,Slides,Cervical Or Vaginal;With Manual Screening And Rescreening Under Physician Supervision |
| 88155-CPT | Low | Cytopathology, Slides, Cervical Or Vaginal, Definitive Hormonal Evaluation (Eg, Maturation Index, Karyopyknotic Index, Estrogenic Index) (List Separately In Addition To Code(S) For Other Technical And Interpretation Services) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88155. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88155 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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