Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesSurgical Pathology ProceduresCPT cpt-88313-special-stain-technical-component
    Ask Trek AI about this page

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

    Medicare pays $56 and commercial payers pay $63 on average nationally for this procedure.

    CPT code 88313 describes the technical component where a laboratory analyst performs special staining of tissue specimens for Group II (other) special stains, such as iron or trichrome stains; the service is a clinical laboratory histology staining procedure typically performed in an anatomic pathology laboratory or hospital pathology lab and results in slides prepared for interpretation and reporting by a qualified provider.

    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).

    Customize your policy alerts

    Sign up for cpt 88313 policy alerts

    Get alerted when payer policies referencing 88313 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    Commercial averages (BUCA) sit slightly above Medicare on mean reimbursement for CPT 88313, with BUCA at $63.40 versus Medicare at $56.30. That gap of $7.10 reflects modest upside in commercial negotiated pricing relative to the national Medicare average across localities. Median values differ where available, but the mean comparison highlights that commercial payers on average pay a small premium over Medicare for this code.

    Dispersion (P75 minus P25) varies meaningfully by payer: Blue Cross Blue Shield shows a wide spread of $49.90 (from $41.80 to $91.70), and Aetna and Cigna also have large spreads of $55.40 and $71.50 respectively, indicating substantial variability in commercial contract rates. UnitedHealth Group is comparatively tighter with a spread of $44.00, while BUCA’s interquartile spread is $53.00 and Medicare’s spread is $69.00, reflecting notable variability across localities.

    National Payer Mean Reimbursement Rates

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with known chronic liver disease and worsening liver function undergoes a percutaneous liver biopsy to evaluate abnormalities seen on imaging and laboratory testing. The specimen is submitted to the histology laboratory where a histotechnologist performs a Group II special stain such as an iron (Prussian blue) stain or a trichrome stain to highlight hepatic iron deposition or fibrosis. The technical component (88313) covers the staining process performed by the laboratory technologist. After staining, a pathologist with anatomic pathology or clinical pathology credentials reviews the prepared slide, interprets the staining pattern in the context of the biopsy, and issues a diagnostic report that may reference underlying diagnoses such as C22.0 (liver cell carcinoma), K74.60 (unspecified cirrhosis of liver), or K76.9 (liver disease, unspecified). Typical site of service is the hospital laboratory or independent clinical laboratory that supports hospital or outpatient biopsy services. The clinical workflow: specimen collection in procedural area → transport to pathology lab → gross accessioning and processing → application of Group II special stain under 88313 (technical staining) → slide review and interpretation by pathologist (professional component reported separately) → final pathology report issued and communicated to ordering clinician.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    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…
    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…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207ZP0102X
    207ZP0101X
    207ZP0007X
    342000000X
    163WG0100X
    3336C0002X
    207VG0400X
    163WX0106X

    Related ICD-10-CM Codes

    32 rows

    ICD-10-CM CodeDescription
    A09Infectious gastroenteritis and colitis, unspecified
    C16.9Malignant neoplasm of stomach, unspecified
    C18.9Malignant neoplasm of colon, unspecified
    C20Malignant neoplasm of rectum
    C22.0Liver cell carcinoma
    D50.9Iron deficiency anemia, unspecified
    D62Acute posthemorrhagic anemia
    E86.0Dehydration
    K21.9Gastro-esophageal reflux disease without esophagitis
    K25.9Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation

    Showing 1–10 of 32

    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-88309-LEVEL-VI-SURGICAL-PATHOLOGY-EXAMINATION

    CPT 88309: Level VI Surgical Pathology 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-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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    0757TDigitization of slides prepared for a group II (other) special stain exam (88313)Ancillary service that digitizes slides prepared with Group II stains to enable remote review, archiving, or telepathology after the technical stain is completed.