CPT 88280 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 | Cytogenetic Studies Pathology and Laboratory Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 88280 |
National average reimbursement for CPT 88280 by major payers:
$30.60
$28.13
$34.29
$48.14
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 88280 | $30.12 | 1659827756 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-GROVE | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 88280 | $55.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 88280 | $20.54 | 1669480323 - KELL WEST REGIONAL HOSPITAL LLC | 752756307 - KELL WEST REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 88280 | $33.47 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 88280 | $30.12 | 1821760430 - PRISMA HEALTH-UPSTATE | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 88280 | $20.08 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 88280 | $33.47 | 1629021845 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, NORTH AUSTIN MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 88280 | $20.94 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 88280 | $78.91 | 1073638490 - SHARRON ACOSTA M.D.P.A. | 742979530 - SHARRON ACOSTA, M.D., P.A. | TX | Ophthalmology Physician (207W00000X) |
United | 88280 | $80.80 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 88280 | $30.12 | 1821544925 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-SENECA | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 88280 | $20.51 | 1366428401 - AARON ASKEW | 911750212 - DESERT BONE & JOINT SPECIALISTS, LLP | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 88280 | $33.47 | 1538522412 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE TRANSMOUNTAIN CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 88280 | $42.29 | 1235122029 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 88280 | $13.77 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | 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 88280 vs. Other Pathology and Laboratory Procedures Codes
The CPT 88280 code is part of the Cytogenetic Studies services used for Pathology and Laboratory 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 88280 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 |
|---|---|---|
| 88272-CPT | Low | Chromosome Genetic Study, The Test Uses A Fluorescent Stain To Detect Dna Sequence In Cells. Dna Sequence Determines An Individuals Genetic Makeup. |
| 88273-CPT | Low | Molecular Cytogenetics Chromo, Molecular Cytogenetics Chromosomal In Situ Hybridizationanalyze 10-30 Cells (Eg For Microdeletions) Molecular Cytogenetics Chromosomal In Situ Hybridization |
| 88274-CPT | Low | Genetic Analysis Of Cells, This Study Uses A Technique That Separates And Recombines A Dna Strand Directly On A Viewing Slide. The Technique Analyzes How A Genetic Alteration Affects The Number Of Genes In A Specified Number Of Cells. |
| 88280-CPT | Low | Additional Genetic Study, Additional Studies Of Full Chromosome Sets That Describes A Persons Genetic Makeup (Karyotypes) Beyond The Base Chromosome Analysis. Karyotypes Help To Identify And Organize Genetic Abnormalities And Can Pinpoint Diagnosis Of Certain Cancers. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88280 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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