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    v1.0.30
    OpenPayerBilling CodesSurgical Pathology ProceduresCPT cpt-88309-level-vi-surgical-pathology-examination
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    CPT 88309: Level VI Surgical Pathology Examination

    Medicare pays $287 and commercial payers pay $299 on average nationally for this procedure.

    CPT code 88309 describes a Level VI surgical pathology examination performed by a physician (commonly a pathologist) that includes accessioning the specimen into the laboratory and a detailed gross and microscopic evaluation with documented findings; service type: surgical pathology (anatomic pathology) consultative examination; typical site of service: hospital pathology laboratory or independent pathology laboratory associated with surgical services.

    For related coverage guidance, see recent payer policy updates: Destruction of Pre-Malignant Skin Lesions, Onychomycosis diagnostic testing and coverage, Treatment of Capillary Malformations (Port Wine Stains).

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    National Reimbursement Benchmarks

    Nationally, Medicare’s mean rate of $287.30 for CPT 88309 is effectively in line with BUCA’s average commercial mean of $299.20, placing Medicare near the middle of the commercial market rather than at the low end. That proximity suggests commercial averages are only modestly higher than Medicare for this code, with both centering around the high $200s; median values vary by payer but are not restated in full here. Dispersion measured by the interquartile range (P75 minus P25) highlights variability across payers: Blue Cross Blue Shield shows a range of $192.00 (from $200.30 to $392.00), BUCA’s IQR is $195.80, Cigna’s IQR is $275.50, Aetna’s IQR is $78.00, and UnitedHealth Group’s IQR is $182.30. Cigna is the widest, indicating the most spread in commercial pricing, while Aetna is the tightest among the listed payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient undergoes a right hemicolectomy for a known malignant neoplasm of the ascending colon. The surgical team submits the resected colon specimen to the hospital pathology laboratory. The pathology accessioner formally receives the specimen, verifies patient identifiers and accompanying clinical information, and assigns a laboratory accession number. A pathologist performs a level VI surgical pathology examination (88309), which includes a detailed gross examination of the specimen, selection and processing of representative tissue sections, microscopic evaluation, correlation with the clinical history and operative findings, and generation of a signed diagnostic report. The report documents tumor type, size, margins, lymph node status if submitted, and any ancillary testing recommendations. Typical site of service is an anatomic pathology laboratory within a hospital or independent clinical laboratory. The service type is surgical pathology (comprehensive gross and microscopic examination) performed by a pathologist.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    88305Level V surgical pathology, gross and microscopic examinationOften used for specimens requiring detailed gross and microscopic evaluation; 88309 represents a higher level comprehensive exam for complex specimens or procedures.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207ZP0102X
    207ZP0101X
    207ZP0104X
    261QM1102X
    207RI0001X
    1835P1200X
    332BP3500X
    3416S0300X

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01
    Topical Acne-Non-Retinoid ProductsCigna2026-08-15
    Dermatology - Vtama Drug Quantity Management Policy - Per DaysCigna2026-08-15
    Medical Necessity Guidelines: Acne and Rosacea Medicationsharvard pilgrim health care2026-08-11
    Dermatology - Anzupgo Prior Authorization PolicyCigna2026-08-05
    Light Therapy for Dermatologic Conditionsbcbsvermont2026-08-01

    Related Codes

    CPT-88300-LEVEL-I-SURGICAL-PATHOLOGY-GROSS-EXAMINATION-ACCESSIONING

    CPT 88300: Surgical Pathology, Level I Gross Examination

    CPT-88302-SURGICAL-PATHOLOGY-LEVEL-II-GROSS-AND-MICROSCOPIC-EXAMINATION

    CPT 88302: Surgical Pathology, Level II Gross and Microscopic Exam

    CPT-88304-SURGICAL-PATHOLOGY-LEVEL-III-GROSS-AND-MICROSCOPIC

    CPT 88304: Surgical Pathology, Level III Examination

    CPT-88305-SURGICAL-PATHOLOGY-LEVEL-IV-EXAMINATION

    CPT 88305: Surgical Pathology, Gross and Microscopic Examination, Level IV

    CPT-88307-SURGICAL-PATHOLOGY-LEVEL-V-EXAMINATION

    CPT 88307: Surgical Pathology Level V Examination

    CPT-88311-DECALCIFICATION-SPECIMEN-PREPARATION

    CPT 88311: Decalcification Procedure for Tissue Specimens

    CPT-88312-SPECIAL-STAIN-MICROORGANISMS-TECHNICAL-COMPONENT

    CPT 88312: Special Stain, Technical Component for Microorganisms

    CPT-88313-SPECIAL-STAIN-TECHNICAL-COMPONENT

    CPT 88313: Technical Special Stain for Group II (e.g., iron, trichrome)

    CPT-88314-FROZEN-TISSUE-HISTOCHEMICAL-SPECIAL-STAIN

    CPT 88314: Frozen Tissue Histochemical Special Stain, Interpretation

    CPT-88319-ENZYME-SPECIAL-STAIN-PATHOLOGY-INTERPRETATION

    CPT 88319: Special Stain for Enzyme Constituents, With Interpretation

    Showing 1–10 of 47

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    88307Level V surgical pathology, gross and microscopic examinationAlternate level V code used for large or complex specimens; may be reported depending on specimen complexity and coding policies.
    88311Decalcification procedure on a specimenReported when specimens (e.g., bone-containing colectomy margins or pelvic specimens) require decalcification before sectioning, often performed prior to microscopic examination.