CPT code 88305: Tissue pathology exam, level IV specimen2026 Medicare rate & RVUs in Georgia
Pathologist gross and microscopic examination of a Level IV specimen, such as a skin, GI tract, breast, or endometrial biopsy.
Medicare pays $65.40–$71.07 for 88305 in the office in Georgia, from Rest of Georgia to Atlanta, GA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 88305 covers
This service covers gross examination and microscopic interpretation of a Level IV tissue specimen, with routine processing, embedding, sectioning, and H&E staining. Common specimens include skin biopsies, gastric and colon biopsies, colorectal polyps, breast core biopsies, endometrial biopsies, and bone marrow core biopsies. Pathologists, including dermatopathologists, examine these specimens in hospital laboratories, independent laboratories, or physician office laboratories.
Report one unit for each separately submitted specimen classified at Level IV; the specimen type, not the number of tissue blocks or slides, determines the level. The pathology report should identify each specimen and its anatomic site, gross findings, and microscopic diagnosis. Separately performed and documented special stains, immunohistochemistry, or decalcification may be reported with the appropriate codes when medically necessary. Without a modifier, 88305 represents the global service. Modifier 26 identifies the pathologist's interpretation and report; modifier TC identifies technical processing, equipment, and staff work. For Medicare prostate needle biopsies, report G0416 for the biopsy case rather than 88305 units for individual cores or specimens.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 88305 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta, GA | $71.07 | Unavailable |
| Rest of Georgia | $65.40 | Unavailable |
How the 88305 rate is calculated
Each of 88305’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 88305
RVUs × geographic indexes × conversion factor
Work0.73
0.73 RVUs× 1.000 GPCI
Practice expense1.35
1.35 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
2.1000
Conversion factor
$33.4009
Medicare rate
$70.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 88305
The CMS indicators that decide how 88305 is paid alongside other services.
CMS payment indicators · 88305
Tissue pathology exam, level IV specimen
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
88305 without 26 · national office
$70.14
Tissue pathology exam, level IV specimen
88305-26 · Professional component
$35.07
Pays only the interpretation and report.
88305 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 88304Tissue pathology examLevel III specimen
- 88304 applies to Level III specimens such as skin cysts, tags, gallbladder, and appendix. Choose 88305 when the submitted specimen type is assigned to Level IV.
- 88307Tissue pathology examLevel V specimen
- 88307 covers specimens assigned to Level V, including some biopsies and more extensive resections. Select the level by specimen type, not specimen size or slide count alone.
- 88300Gross pathologyGross examination only
- 88300 is gross examination only, without microscopic evaluation. When slides are prepared and read, report the appropriate gross and microscopic examination level instead.
- G0416Prostate pathology10–20 specimens
- For Medicare prostate needle biopsies, report G0416 for the biopsy case instead of billing 88305 separately for each core or specimen.
88305 billing questions
How many units are reported when a patient has several biopsies?
Report one unit for each separately submitted specimen, such as biopsies from different colon sites submitted in distinct containers. Multiple pieces of tissue submitted together as one specimen count as one unit.
When is modifier 26 appended?
Append 26 when the pathologist bills only the interpretation, such as when a hospital laboratory processes the slides. The entity billing only the technical work uses TC; an entity billing both components uses no component modifier.
Are special stains or immunostains included?
Routine H&E staining is included. Separately performed and documented special stains (88312, 88313), immunohistochemistry (88342, 88341), or decalcification (88311) may be reported when medically necessary.
How is a Medicare prostate needle biopsy reported?
Report one unit of G0416 for the prostate needle biopsy case, regardless of the number of cores or specimens, rather than per-specimen 88305.
Can a skin cyst be billed at this level?
Skin cysts, tags, and debridements are assigned to Level III (88304). Select 88305 for skin biopsies and excisions classified at Level IV rather than assigning a level based on whether margins are assessed.
What documentation supports the level?
The report should identify each specimen separately, include gross findings and the microscopic diagnosis, and specify the anatomic site so the specimen type supports the Level IV assignment.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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