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CPT 88305: Surgical Pathology, Level IV Examination
CPT code 88305 represents a Level IV surgical pathology examination performed by a physician (usually a pathologist). It covers accessioning a surgical specimen, gross examination, microscopic evaluation, and formal reporting of findings. This code is central to diagnostic workflows for tissue-based diagnoses, including cancer and neoplastic evaluations, and it affects hospital pathology services, independent labs, and surgical follow-up care nationally.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication explains coverage considerations and typical use of 88305 across settings where surgical pathology services are delivered.
Readers will learn the clinical scope of the code, how it relates to adjacent pathology codes for lower and higher complexity examinations, and the common clinical scenarios in which 88305 is applied. The summary outlines service type and typical site of service, highlights common payer coverage patterns, and presents the code's role in pathology service lines. Where available, benchmark and policy context are summarized to clarify coding distinctions and bundled-service interactions. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 88305 describes a Level IV surgical pathology examination performed by a physician, typically a pathologist. The service includes accessioning the surgical specimen into the laboratory, performing a gross examination, preparing and reviewing microscopic sections, and reporting the pathologic findings.
Service Type: Surgical pathology — gross and microscopic examination
Typical Site of Service: Hospital-based pathology laboratory, independent pathology laboratory, or hospital outpatient setting
National Reimbursement Benchmarks
Medicare’s mean reimbursement of $48.6 for CPT 88305 sits well below BUCA’s average commercial mean of $102.3, indicating that commercial contracts on average pay about $53.7 more than Medicare for this service. This gap highlights a substantial difference between public program baseline rates and a representative commercial payer average.
Dispersion varies notably across payers. Blue Cross Blue Shield shows a relatively tight interquartile spread of $47.4 (P75 $124.7 minus P25 $79.3), while Aetna exhibits the widest spread at $193.5 (P75 $237.9 minus P25 $45.9), reflecting much greater variability in Aetna contracted rates. UnitedHealth Group and Cigna display moderate spreads of $40.8 and $43.4 respectively, and BUCA’s interquartile spread is $64.4; Medicare’s IQR is $33 (P75 $68 minus P25 $35).