CPT 88304 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 • Surgical Pathology 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 |
| CMS | $10.67 Physician Fee Schedule |
National average reimbursement for CPT 88304 by major payers:
$50.31
$40.11
$57.72
$47.79
| 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 88304 | ||||||
United | 88304 | $44.04 | 1811074636 - CHARLES CASALE | 135596796 - MARY IMOGENE BASSETT HOSPITAL | MA | Gastroenterology Physician (207RG0100X) |
United | 88304 | $6.30 | 1093235103 - JUDAH HOROWITZ | 112329960 - (NY) ODA PRIMARY HEALTH CARE NETWORK INC | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $11.38 | 1750794244 - MOIZ AHMED | 205392766 - COMMUNITY PHYSICIANS OF INDIANA INC | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $39.11 | 1982659181 - AARON WALFISH | 131624096 - MOUNT SINAI HOSPITAL | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $93.77 | 1124003090 - DAVID ROBBINS | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $47.66 | 1053630285 - KASRA ADHAM | 651313380 - CAPITAL DIGESTIVE CARE, LLC | MD | Gastroenterology Physician (207RG0100X) |
United | 88304 | $107.62 | 1124518428 - MICHAEL MINTZ | 131623978 | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $29.12 | 1124518428 - MICHAEL MINTZ | 131623978 | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $157.71 | 1588648851 - PRAMOD MISTRY | 60646973 - YALE UNIVERSITY | CT | Gastroenterology Physician (207RG0100X) |
United | 88304 | $53.97 | 1619055845 - AMINE HILA | 150532180 - (NY) CHENANGO MEMORIAL HOSPITAL INC | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $69.11 | 1861589954 - CHRISTINE FRISSORA-RODEO | 131623978 | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $107.58 | 1245375088 - CHARLES SILVERA | 131623978 | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $4.82 | 1609882042 - DIGESTIVE DISEASE ASSOCIATES LLP | 161534579 - (NY) DIGESTIVE DISEASE ASSOCIATES, LLP | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $6.01 | 1912093444 - DHIREN MEHTA | 113405179 - (NY) MEHTA & MEHTA PHYSICIANS, P.C. | NY | Gastroenterology Physician (207RG0100X) |
United | 88304 | $20.67 | 1568637924 - ARIYO IHIMOYAN | 132707945 - (NY) BRONXCARE DR MARTIN LUTHER KING JR HEALTH CENTER | 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 Surgical Pathology Procedures Codes
The CPT 88304 code is part of the Pathology and Laboratory Procedures services used for Surgical Pathology 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 | Surg Path; Level 1 Gross Exam |
| 88302-CPT | Low | 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, |
| 88304-CPT | Low | 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 |
| 88305-CPT | Low | 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 |
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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