CPT 88355 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 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 88355 |
| Medicaid Fee Schedule | View Medicaid rates for 88355 |
National average reimbursement for CPT 88355 by major payers:
$170.09
$151.49
$157.65
$167.49
CPT 88355 vs. Other Surgical Pathology Procedures Codes
The CPT 88355 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 88355 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 |
|---|---|---|
| 88355-CPT | Low | 3-D Genetic Analysis Of Tissue, Genetic Material From A Tissue Sample Is Studied Using Morphometric Analysis A Technique For Learning About The Cause And Progression Of A Disease. |
| 88356-CPT | Moderate | 3-D Genetic Analysis Of Tissue, Genetic Material From A Tissue Sample Is Studied Using Morphometric Analysis A Technique For Learning About The Cause And Progression Of A Disease. |
| 88358-CPT | Low | Lab Exam Of Tumor Tissue, Cells From A Tumor Are Collected And Stained. They Are Examined Under A Microscope To Evaluate And Measure Their Structure Composition And Function. |
| 88360-CPT | Low | Tumor Immunohistochem Manual, Morphometric Analysis Tumor Immunohistochemistry Eg Her 2 Neu Estrogen Receptor Progesterone Receptor Quantitative Or Semiquantitative Per Specimen Each Single Antibody Stain Procedure Manual |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88355. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88355 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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