Pathologist's gross and microscopic exam of a surgical tissue specimen at the level IV complexity tier, billed per specimen submitted.
- Medicare
- $70.14
- Work RVU
- 0.73
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Each specimen labeled with tissue type and anatomic site
- Separate containers for separately billed specimens
- Clinical history and pre-op diagnosis on the requisition
- Operative note listing specimens sent
- Pathology report with gross and microscopic findings per specimen
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
88305 is surgical pathology level IV, the most commonly billed pathology level. It covers gross and microscopic examination of tissue specimens that CPT assigns to this tier. Ortho-relevant examples in level IV include synovium, a femoral head removed for fracture, and bone exostosis. Many routine ortho specimens, such as meniscus, ganglion cyst, loose bodies, and femoral heads removed for arthritis, fall in level III (88304), so check the specimen list before coding.
The unit of service is the specimen. Two separately identified and submitted specimens are two units. The pathologist bills the professional component with modifier 26, and the facility or lab bills the technical component with TC, or one global charge when the same entity does both.
Orthopedic practices usually do not bill this code unless they own an in-office pathology lab. The surgeon still matters: an operative note and requisition that clearly name each specimen and its site prevent the pathologist's claim from being cut down to the wrong level or wrong unit count.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.73) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.1) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.73 |
| Practice expense RVU | 1.35 |
| Malpractice RVU | 0.02 |
| Total RVU | 2.1 |
| Medicare national rate | $70.14 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $70.14 |
HOPD (APC 5671) Hospital outpatient department | $53.24 |
Common denial reasons
The recurring reasons claims for CPT 88305 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Specimen type belongs in level III (88304), not level IV
- Units exceed separately submitted specimens
- Global and component billing overlap between pathologist and facility
- Specimen exempt from pathology review under facility policy billed anyway
- Missing distinct-specimen modifier where the payer requires it
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is a meniscus specimen 88304 or 88305?
02How are units counted for 88305?
03Who bills 88305 in an orthopedic case?
04What modifier is used for the professional component of 88305?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the specimens the surgeon names during the case dictation, so the op note lists what was sent and from where.
See how Mira captures CPT 88305 documentation