$69.18–$79.56
88305 covers Level IV specimens, including common skin, colon, and stomach biopsies. 88304 covers Level III specimens such as gallbladders, hemorrhoids, tonsils, and lipomas; select by the CPT specimen list.
On this page
CMS RVU26D · Effective 2026-10-01
88304 Tissue pathology exam Medicare reimbursement rates in Virginia
Report 88304 for a pathologist's gross and microscopic examination of a Level III surgical specimen, such as a gallbladder, hemorrhoid, or tonsil. Compare 88304 office and facility rates across CMS payment localities in Virginia.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 88304 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$40.32–$47.48
2 of 2 localities have a supported rate.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Surgical pathology
About 88304: Level III surgical pathology gross and microscopic exam
Report 88304 for a pathologist's gross and microscopic examination of a Level III surgical specimen, such as a gallbladder, hemorrhoid, or tonsil.
Code 88304 covers gross and microscopic examination of a surgical specimen assigned to Level III in CPT's surgical pathology specimen list. Common examples include gallbladders removed at cholecystectomy, hemorrhoids, tonsils and adenoids, lipomas, skin cysts, intervertebral disc material, and varicose veins. Laboratory staff gross, process, section, and routinely stain the tissue; a pathologist examines the slides and issues a diagnosis. This work occurs in hospital laboratories, independent laboratories, and pathology group practices.
Report one unit for each distinct specimen examined, not automatically for each container or tissue fragment. Select the listed specimen level rather than grading complexity or time; for an unlisted specimen, compare the physician work with listed specimens. Document each specimen's source, gross and microscopic findings, and diagnosis. Modifier 26 identifies the professional component, including interpretation; modifier TC identifies the technical component, including preparation, equipment, and staff. Report the code without either modifier when billing for both components. Separately performed, medically necessary decalcification, special stains, or immunohistochemistry may be reported with the appropriate additional codes.
CMS billing rules for 88304
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU0.21 · 17%
- Practice expense (office) RVU1.00 · 81%
- Malpractice RVU0.02 · 2%
796.5K
Medicare services in 2024 · #168 by national volume
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.
88304 compared with similar codes
Office rates for Virginia, from the same CMS release.
$31.74–$37.58
88302 covers Level II specimens such as an incidental appendix, sterilization fallopian tubes or vas deferens, and hernia sacs. 88304 covers specimens assigned to Level III.
$15.95–$18.90
88300 covers gross examination only, without microscopic review, for items such as foreign bodies. 88304 includes both gross and microscopic examination of a Level III specimen.
Compare 88304 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
$47.48
Facility
Unavailable
Virginia →
Office / nonfacility
$40.32
Facility
Unavailable
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88304 billing questions
How is the level chosen between 88304 and 88305?
Select the level assigned to the specimen type in CPT's surgical pathology list. Gallbladders, hemorrhoids, tonsils, and lipomas are Level III; common skin, colon, and stomach biopsies are Level IV under 88305.
How many units are reported when multiple specimens are submitted?
Report one unit for each distinct specimen identified and examined. Two containers do not automatically mean two specimens, and multiple pieces submitted as one specimen count as one unit.
When should modifiers 26 or TC be used?
Use modifier 26 when billing only the pathologist's professional component and modifier TC when billing only the technical component. Report 88304 without either modifier when billing for both components.
Are special stains or decalcification included in 88304?
Routine tissue staining is part of the examination. Separately performed, medically necessary decalcification, special stains, or immunohistochemistry may be reported with appropriate codes such as 88311, 88312, 88313, or 88342.
What if a specimen is not listed in any level?
Select the level whose listed specimens most closely match the physician work for the unlisted specimen, and document its source and findings.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
11,20088302,,Tissue exam by pathologist,A,,0.13,0.82,,0.82,NA,0.02,0.97,0.97,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,20188302,26,Tissue exam by pathologist,A,,0.13,0.06,,0.06,,0.01,0.20,0.20,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,20288302,TC,Tissue exam by pathologist,A,,0.00,0.76,,0.76,NA,0.01,0.77,0.77,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,20388304,,Tissue exam by pathologist,A,,0.21,1.00,,1.00,NA,0.02,1.23,1.23,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,20488304,26,Tissue exam by pathologist,A,,0.21,0.09,,0.09,,0.01,0.31,0.31,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,20588304,TC,Tissue exam by pathologist,A,,0.00,0.91,,0.91,NA,0.01,0.92,0.92,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,20688305,,Tissue exam by pathologist,A,,0.73,1.35,,1.35,NA,0.02,2.10,2.10,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00