88331 — Pathology examination of specimen during surgery, first tissue block

What the market charges

Across 17,123 negotiated rates, the middle 80% fall between $19 and $141, with a median of $52.

What Medicare pays

Medicare allowed an average of $72 for this code, across 264,788 services billed by 4,356 providers. At the median, the market charges less than Medicare pays for this code — 28% less.

Where this is billed, and what it costs there

The states billing 88331 most, by Medicare service volume, each compared against the national average of $72. Each links to the providers Mishe lists there.

• Florida — 338 providers billed it, Medicare allowed $80 — 11% above the national average
• Texas — 343 providers billed it, Medicare allowed $76 — 6% above the national average
• California — 415 providers billed it, Medicare allowed $76 — 6% above the national average
• Arkansas — 55 providers billed it, Medicare allowed $85 — 18% above the national average
• New York — 273 providers billed it, Medicare allowed $69 — 4% below the national average
• Pennsylvania — 177 providers billed it, Medicare allowed $68 — 6% below the national average
• Virginia — 113 providers billed it, Medicare allowed $86 — 19% above the national average
• Minnesota — 93 providers billed it, Medicare allowed $64 — 11% below the national average

Claim-editing rules

These are National Correct Coding Initiative procedure-to-procedure edits — the rules a payer applies when deciding whether two codes billed together are both payable.

Codes this one absorbs

Billed together, 88331 is the payable code and these are not separately payable. 8 pairs in total.

• 88160 — a modifier may allow both to be paid
• 88161 — a modifier may allow both to be paid
• 88162 — a modifier may allow both to be paid
• 88329 — a modifier may allow both to be paid
• 88333 — a modifier may allow both to be paid
• 88334 — a modifier may allow both to be paid
• 88387 — a modifier may allow both to be paid
• 96523 — no modifier can override this edit

Codes that absorb this one

Billed alongside any of these, 88331 is not separately payable. 2 pairs in total.

• 17311 — a modifier may allow both to be paid
• 17313 — a modifier may allow both to be paid

Other codes

• 99214 — Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
• 99213 — Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more
• 97530 — Therapy procedure using functional activities
• 99232 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes
• 97112 — Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes
• 99233 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes
• 88305 — Pathology examination of tissue using a microscope, intermediate complexity
• 99309 — Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes
• 87798 — Detection test by nucleic acid for organism, amplified probe technique
• 98941 — Chiropractic manipulative treatment, 3-4 spinal regions

Deploy this for your team

Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.

• Contact Mishe to learn how to deploy these resources for your team
• Guides to direct-pay healthcare
• Cash prices by procedure
• Find a provider by state

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