CPT 88313 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 | • 11 - Office • 81 - Independent Laboratory • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Low |
| CMS | $79.57 Physician Fee Schedule |
National average reimbursement for CPT 88313 by major payers:
$87.71
$60.51
$91.39
$81.27
| 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 88313 | ||||||
United | 88313 | $7.36 | 1841317526 - SHAIL GOVANI | 263328413 - (OH) UNION COUNTY PHYSICIAN CORPORATION | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $8.84 | 1417047697 - SAVREET SARKARIA | 756002868 | PA | Gastroenterology Physician (207RG0100X) |
United | 88313 | $38.75 | 1437110699 - JAMES HOSLER | 815158335 | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $7.57 | 1548393747 - BENNY LIU | 943302014 | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $46.34 | 1205824810 - AMIR AHMED | 882594493 - (TX) MODERA CLINIC GI PLLC | MO | Gastroenterology Physician (207RG0100X) |
United | 88313 | $36.72 | 1427248608 - MUHAMMAD ALI | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | WI | Gastroenterology Physician (207RG0100X) |
United | 88313 | $10.10 | 1639179500 - MICHAEL PAOLUCCI | 841357778 - (CO) PEAK GASTROENTEROLOGY ASSOC P.C. | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $36.95 | 1104085919 - DIGESTIVE CENTER ASSOCIATES PLLC | 262466786 | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $46.34 | 1497121685 - THUC QUYEN NGUYEN MD, PLLC | 474526334 - (TX) THUC QUYEN NGUYEN MD PLLC | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $69.44 | 1003807520 - SAHIBZADA SHAH | 866007596 - (AZ) YUMA REGIONAL MEDICAL CENTER | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $45.22 | 1316929375 - DANIEL PODOLSKY | 756002868 | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $44.31 | 1053377101 - JOB JACOB | 161727596 - DIGESTIVE & LIVER CENTER OF FL, PA | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $22.97 | 1275533150 - LINDY RACHAL | 272184637 | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $38.75 | 1508864489 - EDISON RODRIGUES | 752616977 - CHRISTUS TRINITY CLINIC | TX | Gastroenterology Physician (207RG0100X) |
United | 88313 | $43.81 | 1427248608 - MUHAMMAD ALI | 741967809 - (TX) GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, P.A. | TX | 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 88313 vs. Other Surgical Pathology Procedures Codes
The CPT 88313 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 88313 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 |
|---|---|---|
| 88311-CPT | Low | Decalc Proced-List W/Surg.Path.Exam |
| 88312-CPT | Low | Special Stains (List Separately In Addition To Code For Primary Service); Group I For Microorganisms (Eg Gridley Acid Fast Methenamine Silver) Each (Rvsd 1/1/04) |
| 88313-CPT | Low | Special Stain Including Interpretation And Report; Group Ii, All Other (Eg, Iron, Trichrome), Except Stain For Microorganisms, Stains For Enzyme Constituents, Or Immunocytochemistry And Immunohistochemistry |
| 88314-CPT | Low | Special Stain Including Interpretation And Report; Histochemical Stain On Frozen Tissue Block (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88313. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88313 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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