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CPT 88309: Level VI Surgical Pathology Examination
CPT code 88309 represents a Level VI surgical pathology examination in which a pathologist performs accessioning, gross examination, and microscopic evaluation of a surgical specimen and reports the findings. This code captures complex surgical pathology work essential to definitive diagnosis, staging, and treatment planning for a wide range of neoplastic and non-neoplastic conditions. Its use affects billing, clinical documentation, and pathology workflow nationally because it reflects a high-complexity professional pathology service.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an explanation of the clinical service represented by the code, comparisons to related pathology codes, and common coding contexts for surgical specimens. The publication also outlines typical sites of service and the clinical scenarios that commonly generate Level VI examinations, helping billing and compliance teams align documentation with code selection.
The report provides operational and policy-oriented information useful to pathology departments, hospital coding teams, and payer relations staff: core code definition, where it fits among related pathology codes, common clinical indications, and the elements of service that justify Level VI classification. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 88309 describes a Level VI surgical pathology examination performed by a physician, typically a pathologist. The service includes formal accessioning of the specimen into the laboratory, a detailed gross examination, and microscopic evaluation with reporting of findings.
Service Type: Surgical pathology—comprehensive gross and microscopic examination
Typical Site of Service: Hospital-based pathology laboratory or independent pathology laboratory supporting surgical services
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.