CPT 88309 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
| CMS | $280.12 Physician Fee Schedule |
National average reimbursement for CPT 88309 by major payers:
$434.45
$325.89
$468.49
$430.91
| 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 88309 | ||||||
United | 88309 | $199.97 | 1306836259 - KEVIN OHARA | 300868541 | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 88309 | $149.44 | 1700820487 - MOHAMED ABDULLA | 232380812 - ST LUKES PHYSICIAN GROUP INC | PA | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | 88309 | $811.72 | 1578052155 - PAUL KIM | 232919472 - UPMC | PA | Emergency Medicine Physician (207P00000X) |
United | 88309 | $271.54 | 1528057429 - THOMAS MCLOUGHLIN | 232700908 - (PA) LEHIGH VALLEY PHYSICIAN GROUP | PA | Anesthesiology Physician (207L00000X) |
United | 88309 | $407.14 | 1336107788 - ROBERT DEQUEVEDO | 232380812 - ST LUKES PHYSICIAN GROUP INC | PA | Anesthesiology Physician (207L00000X) |
United | 88309 | $609.76 | 1548524275 - JAMES BOULDEN | 550357057 - WHEELING HOSPITAL INC | PA | Emergency Medicine Physician (207P00000X) |
United | 88309 | $510.75 | 1194215566 - MATTHEW MAGDA | 232743545 | PA | Emergency Medicine Physician (207P00000X) |
United | 88309 | $468.22 | 1740257492 - IKENNA OBIOMA | 251881378 | PA | Anesthesiology Physician (207L00000X) |
United | 88309 | $159.33 | 1174784441 - IBRAHIM KHALIFEH | 831002191 - TEMPLE FACULTY PRACTICE PLAN INC | OH | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | 88309 | $146.64 | 1336553841 - ANNI XU | 232449454 - (PA) UPMC | PA | Emergency Medicine Physician (207P00000X) |
United | 88309 | $561.53 | 1144510603 - AHMED FADL | 251838458 - HIGHMARK HEALTH | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 88309 | $199.97 | 1629023452 - ANNA CONTENTO | 250969492 - (PA) HIGHMARK HEALTH | PA | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | 88309 | $610.72 | 1356321459 - ELIE AZAR | 300976099 | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 88309 | $199.97 | 1629394481 - FRANCISCA OYEDEJI | 251838458 - HIGHMARK HEALTH | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 88309 | $173.88 | 1659518389 - BUTLER IMAGING AND INTERVENTIONAL ASSOCIATES LLC | 264263364 - (PA) BUTLER IMAGING AND INTERVENTIONAL ASSOCIATES LLC | PA | Diagnostic Radiology Physician (2085R0202X) |
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 88309 vs. Other Surgical Pathology Procedures Codes
The CPT 88309 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 88309 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 |
| 88309-CPT | Moderate | Level Vi - Surgical Pathology, Gross And Microscopic Examination Bone Resection Breast, Mastectomy - With Regional Lymph Nodes Colon, Segmental Resection For Tumor Colon, Total Resection Esophagus, Partial/Total Resection Extremity, Disarticulation Fetus, With Diss |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88309. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88309 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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