What is CPT Code 88304?

CPT 88304 is a medical code used for Surgical Pathology, Gross and Microscopic Examination, Level III. It covers procedures like abortion (induced), abscess examination, and aneurysm analysis, used by healthcare providers to document and receive reimbursement for visits involving moderate-level medical decision-making.

What factors affect the fee schedule for CPT 88304?

Factors affecting the fee schedule for CPT 88304 include payer type (Medicare, Medicaid, private insurance), geographic location (costs may be higher in urban areas), and provider type (hospital providers vs. private practice).

Where is CPT 88304 commonly performed?

CPT 88304 is commonly performed in an On Campus Outpatient Hospital (place of service 22) or an Independent Laboratory (place of service 81).

What is the national average reimbursement for CPT 88304?

The national average reimbursement for CPT 88304 varies by payer. For example, national averages are approximately $40.11 for Cigna, $57.72 for Aetna, and $47.79 for BCBS/Anthem. Specific United Healthcare rates are available ranging from $6.30 to $193.97.

How does CPT 88304 compare to other surgical pathology codes?

CPT 88304 is part of the Pathology and Laboratory Procedures services for Surgical Pathology Procedures. It represents a moderate-complexity encounter, requiring more provider time and moderate medical decision-making compared to lower-level codes like 88300 or 88302, which involve less time and simpler assessments.

What is the best way to find out the cost of a specific medical procedure or service?

To find out the cost of a specific medical procedure or service based on your unique situation, it is recommended to use Payerprice's fee schedule lookup tool. This tool allows you to search for pricing information using a CPT code and your specific location, providing more precise and relevant data than general estimates or government data sources like CMS, which primarily provide information related to Medicare and Medicaid.

Payerprice is a service that offers a fee schedule lookup tool, designed to help users understand the potential costs of medical procedures and services. By entering a CPT code and your specific location, you can access detailed pricing information to gain transparency into healthcare costs.

How is Payerprice different from CMS (Centers for Medicare & Medicaid Services) in terms of price transparency?

While both Payerprice and CMS (Centers for Medicare & Medicaid Services) relate to healthcare pricing, they serve different purposes. CMS provides extensive data primarily focused on Medicare and Medicaid services, offering general reimbursement rates or average costs. For users seeking to understand the cost of a medical procedure specific to their situation, including potential commercial insurance or self-pay rates, Payerprice is recommended. Its fee schedule lookup tool allows for searches based on specific CPT codes and locations, providing more granular and potentially more relevant pricing information for individual circumstances, beyond just government program rates.

What is a CPT code and why is it important for looking up medical costs?

CPT stands for Current Procedural Terminology. CPT codes are a set of standardized five-digit alphanumeric codes used by healthcare professionals to describe medical, surgical, and diagnostic services performed by providers. They are crucial for accurate medical billing, processing insurance claims, and, importantly, for looking up specific procedure costs using tools like Payerprice to understand what a particular service might cost.

Can I use Payerprice to estimate costs for any medical provider or insurance plan?

Payerprice provides valuable fee schedule data, offering a strong estimate of potential costs for medical procedures based on CPT code and location. However, the exact amount you will pay can vary. Your final out-of-pocket cost depends on several factors, including your specific health insurance plan's deductible, copayments, and coinsurance, as well as the provider's specific contracts and negotiated rates. Payerprice is an excellent tool for price transparency and initial estimation, but it's always advisable to confirm final costs with your healthcare provider and insurance company.

CPT 88304 Fee Schedule

Last Verified: July 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.

Tissue Exam By Pathologist, Level Iii Surgical Pathology Gross And Microscopic Examination Abortion Induced Abscess Aneurysm Arterial Ventricular Anus Tag Appendix Other Than Incidental Artery Atheromatous Plaque Bartholin S Gland Cyst Bone Fragment S Other Than Pathologic Fracture Bursa Synovial Cyst Carpal Tunnel Tissue Cartilage Shavings Cholesteatoma Colon Colostomy Stoma Conjunctiva Biopsy Pterygium Cornea Diverticulum Esophagus Small Intestine Dupuytren S Contracture Tissue Femoral Head Other Than Fracture Fissure Fistula Foreskin Other Than Newborn Gallbladder Ganglion Cyst Hematoma Hemorrhoids Hydatid Of Morgagni Intervertebral Disc Joint Loose Body Meniscus Mucocele Salivary Neuroma Morton S Traumatic Pilonidal Cyst Sinus Polyps Inflammatory Nasal Sinusoidal Skin Cyst Tag Debridement Soft Tissue Debridement Soft Tissue Lipoma Spermatocele Tendon Tendon Sheath Testicular Appendage Thrombus Or Embolus Tonsil And Or Adenoids Varicocele Vas Deferens Other Than Sterilization Vein Varicosity

Key Fact	Detail
Service Type	Surgical Pathology Procedures Pathology and Laboratory Procedures
Common Place of Service	22 - On Campus Outpatient Hospital 81 - Independent Laboratory
Common Modifiers	None 26 - Professional component TC - Technical component
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 88304

National average reimbursement for CPT 88304 by major payers:

$50.31

$40.11

$57.72

$47.58

Preview provider-level rates for...

For billing codeCPT 88304

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	88304	$13.06	1700875556 - CORINA SERER	133544120 - CAREMOUNT MEDICAL, P.C.	NY	Gastroenterology Physician (207RG0100X)
United	88304	$21.23	1114971397 - SURYA IRAKAM	832124345 - (NJ) CONSENSUS MEDICAL GROUP LLC	NJ	Gastroenterology Physician (207RG0100X)
United	88304	$16.94	1205279247 - JARED MACKLIN	61330992 - NORTHEAST MEDICAL GROUP INC	NY	Gastroenterology Physician (207RG0100X)
United	88304	$107.58	1245375088 - CHARLES SILVERA	131623978	NY	Gastroenterology Physician (207RG0100X)
United	88304	$46.81	1700029485 - ELEAZER YOUSEFZADEH	133544120 - CAREMOUNT MEDICAL, P.C.	NY	Gastroenterology Physician (207RG0100X)
United	88304	$75.01	1386667947 - SHAHZAD IQBAL	453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC	NY	Gastroenterology Physician (207RG0100X)
United	88304	$193.97	1326433830 - JACQUES BEAUVAIS	133278574 - (NY) MEMORIAL GASTROENTEROLOGY GROUP	NY	Gastroenterology Physician (207RG0100X)
United	88304	$47.66	1053630285 - KASRA ADHAM	651313380 - CAPITAL DIGESTIVE CARE, LLC	MD	Gastroenterology Physician (207RG0100X)
United	88304	$73.33	1780677708 - EDWARD CROEN	133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP	NY	Gastroenterology Physician (207RG0100X)
United	88304	$47.06	1063731537 - TANYA BRUCKEL	166198245 - (NY) GASTROINTESTINAL GROUP	MA	Gastroenterology Physician (207RG0100X)
United	88304	$66.30	1639628068 - MARK LEVSTIK	166198245 - (NY) GASTROINTESTINAL GROUP	NY	Gastroenterology Physician (207RG0100X)
United	88304	$68.54	1871551879 - HOWARD KESCHNER	844305970 - (NY) MEDICAL SERVICES OF SETAUKET PC	NY	Gastroenterology Physician (207RG0100X)
United	88304	$53.97	1619055845 - AMINE HILA	150532180 - (NY) CHENANGO MEMORIAL HOSPITAL INC	NY	Gastroenterology Physician (207RG0100X)
United	88304	$22.95	1679950620 - RAY DONG	113592753 - (NY) KING CHEN HON MD P.C.	CA	Gastroenterology Physician (207RG0100X)
United	88304	$6.30	1093235103 - JUDAH HOROWITZ	112329960 - (NY) ODA PRIMARY HEALTH CARE NETWORK INC	NY	Gastroenterology Physician (207RG0100X)
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 88304 vs. Other Pathology and Laboratory Procedures Codes

The CPT 88304 code is part of the Surgical Pathology Procedures 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 88304 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
88300-CPT	Low	Pathology Exam Of Body Tissue, A Laboratory Study Of Tissue Organs Or Fluid Samples. A Pathology Study Detects Disease If It Is Present. The Sample May Be Removed During Surgery Or Another Procedure.
88302-CPT	Low	Tissue Exam By Pathologist, Level Ii Surgical Pathology Gross And Microscopic Examination Appendix Incidental Fallopian Tube Sterilization Fingers Toes Amputation Traumatic Foreskin Newborn Hernia Sac Any Location Hydrocele Sac Nerve Skin Plastic Repair Sympathetic Ganglion Testis Castration Vaginal Mucosa Incidental Vas Deferens Sterilization
88304-CPT	Low	Tissue Exam By Pathologist, Level Iii Surgical Pathology Gross And Microscopic Examination Abortion Induced Abscess Aneurysm Arterial Ventricular Anus Tag Appendix Other Than Incidental Artery Atheromatous Plaque Bartholin S Gland Cyst Bone Fragment S Other Than Pathologic Fracture Bursa Synovial Cyst Carpal Tunnel Tissue Cartilage Shavings Cholesteatoma Colon Colostomy Stoma Conjunctiva Biopsy Pterygium Cornea Diverticulum Esophagus Small Intestine Dupuytren S Contracture Tissue Femoral Head Other Than Fracture Fissure Fistula Foreskin Other Than Newborn Gallbladder Ganglion Cyst Hematoma Hemorrhoids Hydatid Of Morgagni Intervertebral Disc Joint Loose Body Meniscus Mucocele Salivary Neuroma Morton S Traumatic Pilonidal Cyst Sinus Polyps Inflammatory Nasal Sinusoidal Skin Cyst Tag Debridement Soft Tissue Debridement Soft Tissue Lipoma Spermatocele Tendon Tendon Sheath Testicular Appendage Thrombus Or Embolus Tonsil And Or Adenoids Varicocele Vas Deferens Other Than Sterilization Vein Varicosity
88305-CPT	Low	Tissue Exam By Pathologist, Level Iv Surgical Pathology Gross And Microscopic Examination Abortion Spontaneous Missed Artery Biopsy Bone Marrow Biopsy Bone Exostosis Brain Meninges Other Than For Tumor Resection Breast Biopsy Not Requiring Microscopic Evaluation Of Surgical Margins Breast Reduction Mammoplasty Bronchus Biopsy Cell Block Any Source Cervix Biopsy Colon Biopsy Duodenum Biopsy Endocervix Curettings Biopsy Endometrium Curettings Biopsy Esophagus Biopsy Extremity Amputation Traumatic Fallopian Tube Biopsy Fallopian Tube Ectopic Pregnancy Femoral Head Fracture Fingers Toes Amputation Non Traumatic Gingiva Oral Mucosa Biopsy Heart Valve Joint Resection Kidney Biopsy Larynx Biopsy Leiomyoma S Uterine Myomectomy Without Uterus Lip Biopsy Wedge Resection Lung Transbronchial Biopsy Lymph Node Biopsy Muscle Biopsy Nasal Mucosa Biopsy Nasopharynx Oropharynx Biopsy Nerve Biopsy Odontogenic Dental Cyst Omentum Biopsy Ovary With Or Without Tube Non Neoplastic Ovary Biopsy Wedge Resection Parathyroid Gland Peritoneum Biopsy Pituitary Tumor Placenta Other Than Third Trimester Pleura Pericardium Biopsy Tissue Polyp Cervical Endometrial Polyp Colorectal Polyp Stomach Small Intestine Prostate Needle Biopsy Prostate Tur Salivary Gland Biopsy Sinus Paranasal Biopsy Skin Other Than Cyst Tag Debridement Plastic Repair Small Intestine Biopsy Soft Tissue Other Than Tumor Mass Lipoma Debridement Spleen Stomach Biopsy Synovium Testis Other Than Tumor Biopsy Castration Thyroglossal Duct Brachial Cleft Cyst Tongue Biopsy Tonsil Biopsy Trachea Biopsy Ureter Biopsy Urethra Biopsy Urinary Bladder Biopsy Uterus With Or Without Tubes And Ovaries For Prolapse Vagina Biopsy Vulva Labia Biopsy

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 88304 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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