CPT 88358 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 Only (separate from technical component) • TC - Technical component: Under certain circumstances a charge may be made for the technical component alone. Under those circumstances the technical component charge is identified by adding modifier TC to the usual procedure code number. This modifier must be reported in the first modifier field |
| Complexity Level | Moderate |
National average reimbursement for CPT 88358 by major payers:
$151.01
$96.31
$120.82
$130.81
| 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 88358 | ||||||
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CPT 88358 vs. Other Surgical Pathology Procedures Codes
The CPT 88358 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 88358 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 | Low | Morphometric Analysis; Skeletal Muscle |
| 88356 | Moderate | Morphometric Analysis; Nerve |
| 88358 | Low | Morphometric Analysis; Tumor |
| 88360 | Low | Mophometric Analysis Tumor Immunohistochemistry (Eg; Her-2/Neu Estrogen Receptor/Progesterone Receptor) Quantitative Or Semiquantitative Per Specimen Each Single Antibody Stain Procedure; Manual (Desc Revised 01/01/15) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88358. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88358 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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