CPT 88342 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 • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| CMS | $109.01 Physician Fee Schedule |
National average reimbursement for CPT 88342 by major payers:
$112.30
$86.32
$121.67
$109.67
| 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 88342 | ||||||
United | 88342 | $61.83 | 1376583641 - GASTROENTEROLOGY ASSOCIATES OF NORTHERN NEW YORK PC | 141686703 - (NY) GASTROENTEROLOGY ASSOCIATES OF NORTHERN NY, PC | NY | Gastroenterology Physician (207RG0100X) |
United | 88342 | $30.81 | 1376862227 - NICHOLAS DAY | 611654232 - (NY) WESTERN NEW YORK MEDICAL PRACTICE PC | NY | Gastroenterology Physician (207RG0100X) |
United | 88342 | $19.70 | 1255573671 - ASHLEY MARANINO | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | VT | Gastroenterology Physician (207RG0100X) |
United | 88342 | $57.31 | 1205087087 - MAZEN NOUREDDIN | 202798379 - (TX) CLEAR LAKE SPECIALTIES, PA | TX | Gastroenterology Physician (207RG0100X) |
United | 88342 | $59.59 | 1942287792 - CHE-NAN CHUANG | 264772401 - (NY) SANFORD ENDOSCOPY PLLC | NY | Gastroenterology Physician (207RG0100X) |
United | 88342 | $37.97 | 1255573671 - ASHLEY MARANINO | 900603487 - (NY) PHYSICIAN AFFILIATE GROUP OF NEW YORK PC | VT | Gastroenterology Physician (207RG0100X) |
United | 88342 | $56.25 | 1821076951 - HUDSON VALLEY GASTROENTEROLOGY ASSOCIATES, PC | 141742535 - (NY) HUDSON VALLEY GASTROENTEROLOGY ASSOCIATES, P.C. | NY | Gastroenterology Physician (207RG0100X) |
United | 88342 | $34.95 | 1730115528 - JAMES JACKSON | 741967809 - (TX) GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, P.A. | TX | Gastroenterology Physician (207RG0100X) |
United | 88342 | $487.30 | 1801281167 - RACHEL NIEC | 133278574 - (NY) MEMORIAL GASTROENTEROLOGY GROUP | NY | Gastroenterology Physician (207RG0100X) |
United | 88342 | $65.08 | 1881795052 - CHING WANG | 203856995 - (TX) GRACE CLINIC OF LUBBOCK | AZ | Gastroenterology Physician (207RG0100X) |
United | 88342 | $14.85 | 1588674428 - SHAHID MEHBOOB | 161569074 - (NY) GASTROENTEROLOGY ASSOCIATES, LLP | NY | Gastroenterology Physician (207RG0100X) |
United | 88342 | $152.38 | 1124472782 - BASHAR SHARMA | 60646768 - HOSPITAL OF CENTRAL CONNECTICUT AT NEW BRITAIN GENERAL AND BRADLEY ME | NY | Gastroenterology Physician (207RG0100X) |
United | 88342 | $64.30 | 1497970867 - BAY AREA HOUSTON GASTROENTEROLOGY ASSOCIATES | 562454024 - (TX) BAY AREA HOUSTON GASTROENTEROLOGY ASSOCIATES | TX | Gastroenterology Physician (207RG0100X) |
United | 88342 | $22.35 | 1174564694 - BOYD FENTON | 752660403 - (TX) HENDRICK PROVIDER NETWORK | TX | Gastroenterology Physician (207RG0100X) |
United | 88342 | $55.95 | 1740449313 - CHARLES OLINER | 352249024 - (NY) AHAVA MEDICAL AND REHABILITATION CENTER LLC | 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 88342 vs. Other Surgical Pathology Procedures Codes
The CPT 88342 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 88342 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) |
| 88341-CPT | Low | Immunohistochemistry Or Immunocytochemistry, Per Specimen; Each Additional Single Antibody Stain Procedure (List Separately In Addition To Code For Primary Procedure) |
| 88342-CPT | Low | Immunohistochemistry Or Immunocytochemistry Per Specimen; Initial Single Antibody Stain Procedure (Desc Revised 01/01/15) Separately Identifiable Antibody Per Slide (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88342 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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