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CPT 88304: Surgical Pathology Level III, Gross and Microscopic Examination
CPT code 88304 designates a Level III surgical pathology examination in which a pathologist accessioning a surgical specimen performs gross and microscopic evaluation and issues a diagnostic report. This code captures routine, non-complex surgical pathology cases that require both gross handling and light microscopy, making it a common and essential component of surgical diagnostic workflows nationwide. Proper coding of 88304 affects clinical documentation, lab workflow, and billing consistency across inpatient and outpatient surgical settings.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and billing considerations relevant to these major payers and summarizes common clinical contexts in which 88304 is reported (for example, evaluation of skin lesions, breast lumps, colon polyps, and other excised tissue).
Readers will find a concise explanation of the clinical service represented by 88304, comparisons to related pathology codes, and operational benchmarks relevant to pathology service lines. The report also highlights documentation elements tied to accurate reporting, typical sites of service (hospital and independent pathology laboratories), and the scope of cases appropriate for Level III surgical pathology. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 88304 describes a Level III surgical pathology examination performed by a physician, typically a pathologist. The service includes receiving and accessioning the surgical specimen into the laboratory, conducting a gross examination of the specimen, evaluating microscopic features, and documenting findings in a formal pathology report.
Service type: Surgical pathology; gross and microscopic examination (Level III)
Typical site of service: Hospital pathology laboratory or independent pathology/diagnostic laboratory serving surgical suites and ambulatory surgical centers
National Reimbursement Benchmarks
Medicare’s mean rate of $28.5 sits below BUCA’s average commercial mean of $63.7, indicating Medicare reimburses substantially less than this commercial benchmark for CPT 88304. The two averages frame a wide national spread between public and higher-end commercial reimbursements, with BUCA roughly $35.2 higher than Medicare on average.
Dispersion (P75−P25) highlights variability by payer: Blue Cross Blue Shield shows the widest interquartile spread at $34.1 ($100.7−$67.6), followed by BUCA at $33.2 ($77.8−$45.6), while Aetna’s spread is $35.4 ($53.2−$18.2) which is slightly larger than BCBS and BUCA; Cigna’s spread is $35.9 ($49.3−$14.4) and UnitedHealth Group’s is $32.2 ($39.3−$16.1). Overall, Cigna and Aetna demonstrate among the largest IQRs, and UnitedHealth Group the tightest of the listed commercial payers.