What is CPT Code 88305
CPT 88305 is one of the most widely used pathology codes in medicine.
It applies to surgical pathology, Level IV.
That means it covers both the gross examination (visual inspection) and microscopic examination (under the scope) of tissue specimens.
In the gross exam, the pathologist inspects the tissue with the naked eye. They measure the specimen.
They note its shape, color, and texture. They check for visible tumors, ulcers, polyps, or irregularities.
This step sets the stage for what comes next.
The microscopic exam is where the real detective work happens.
The pathologist slices the specimen into thin sections, stains them, and studies them under a microscope.
They look for cancer cells, inflammation, infection, dysplasia, or other structural changes.
This is the gold standard for confirming or ruling out disease.
You’ll use CPT 88305 for a wide variety of specimens — skin moles, colon polyps, stomach biopsies, cervical/endometrial tissue, breast lumps, prostate cores, and more.
If you perform endoscopies, skin excisions, or gynecological procedures, you’re probably generating 88305 charges daily.
Why is it so important?
Because each unit of 88305 represents a billable pathology service — and with Medicare paying around $75–$85 per unit and commercial plans paying $90–$120, the volume quickly adds up.
For many practices, 88305 revenue is a significant part of the monthly cash flow.
But here’s the catch: 88305 is billed per specimen, not per slide or jar.
If you put multiple lesions in the same jar, you just cut your revenue.
For example, three skin lesions in three separate jars = three billable units. Three lesions in one jar = one billable unit. That’s a $150–$250 loss on the spot.
In short, CPT 88305 isn’t just a code. It’s a high-volume, high-impact revenue driver.
Handle specimens right, code it correctly, and it will consistently pay you for the work you’re already doing.
When and How to Use CPT 88305
You can’t use 88305 for every tissue sample. The CPT book lists the exact types it applies to. This includes skin, GI tract biopsies, endometrium, cervix, prostate, and single lymph nodes. You bill per specimen, not per slide.
A specimen is one distinct tissue sample from a specific site. A slide is just a slice of that specimen. If you take three separate lesions from three sites and send them in three jars, you bill 88305 three times. If they go into one jar, you bill once. The number of slides doesn’t change that rule.
Here’s how you can bill
Not for every tissue sample – Use only for specific specimen types listed in CPT:
- Skin samples
- GI tract biopsies
- Endometrial tissue
- Cervical biopsies
- Prostate cores
- Single lymph nodes
Bill per specimen, not per slide
- Specimen = one distinct tissue sample from one site.
- Slide = a thin slice of the specimen for microscopic review.
- The number of slides prepared does not affect billing.
Separate jars = more billable units
- 3 lesions from 3 sites in 3 jars → Bill 88305 three times.
- 3 lesions from 3 sites in 1 jar → Bill 88305 once.
Specimen handling impacts revenue
- Proper labeling and jar separation can prevent $100+ losses per case.
- Staff education on this rule avoids underbilling.
The Per Specimen Rule
Many practices lose revenue because of poor specimen handling. Staff often combine multiple biopsies into one jar. They think it saves time, but it cuts billable units.
Medicare pays around $75–$85 per unit. Commercial plans can pay $90–$120.
Per the Specimen Rule, it says:
- One jar = one unit – No matter how many tissue pieces are inside.
- Separate jars = separate units – Each labeled container from a different site is billable.
- Why it matters:
- Medicare pays $75–$85 per unit.
- Commercial plans pay $90–$120 per unit.
- Combining three specimens into one jar can mean $150–$250 is lost instantly.
- The common mistake:
- Staff combine multiple biopsies into one container to “save time.”
- This shortcut reduces billable units and directly cuts revenue.
Global Billing, Split Billing, and Modifiers
CPT 88305 has two parts. The technical Component (TC) covers lab work, slide cutting, and staining. The professional Component (26) covers the pathologist’s interpretation and report.
- If you perform both, bill globally with no modifier.
- When you only interpret slides, bill with modifier 26.
- If you only do the lab work, bill with modifier TC.
Many claims get denied because the wrong billing method was used. Know what part you provided and code it correctly every time.
Two Parts of CPT 88305
- Technical Component (TC) – Covers the lab side. This includes receiving the specimen, processing it, cutting slides, and staining them.
- Professional Component (26) – Covers the pathologist’s work. This includes reviewing the slides under a microscope, interpreting results, and writing the report.
Global Billing (No Modifier)
- Use global billing when you provide both the technical and professional components.
- No modifier is needed.
- Common for in-house pathology labs where the pathologist is on staff.
Split Billing
- If only one Component is provided, you must split the bill:
- Use modifier 26 if you only interpret slides (professional Component).
- Use modifier TC if you only perform the lab work without interpretation.
Linking CPT 88305 to the Right ICD-10
The diagnosis code must explain why the pathology was done.
It’s not enough to say “biopsy.” You need the clinical reason.
For a skin lesion, you might use D48.5.
For gastritis, K29.70. For a colon polyp, K63.5.
The ICD-10 must match the medical necessity for the service.
If it doesn’t, payers will deny the claim. Always link each billed specimen to its correct diagnosis code.
Documentation That Passes Payer Scrutiny
Payers expect complete documentation.
- The pathology report must name the specimen site.
- It should include a gross description and microscopic findings.
- It must have a final diagnosis and the related ICD-10 code.
- The specimen count must match the billed units.
If anything is missing, you risk denials. Keep your pathology logs and billing logs aligned to avoid mismatches.
Bundling Rules and Who Bills 88305
The surgeon or proceduralist doesn’t bill 88305. The pathologist does.
For example, a GI doctor bills 43239 for the biopsy procedure. The pathologist bills 88305 for examining the specimen. These are separate services by separate providers.
Payers expect that split. Mixing them up can trigger audits.
Reimbursement Guidelines
Medicare typically pays $75–$85 per unit for global billing. Commercial payers can pay $90–$120 or more. The RVU value is around 1.92 for global billing.
If you process 500 specimens per month and mishandle even 10%, you could lose $5,000–$6,000 a month. Small mistakes here add up fast.
Common Billing Mistakes and How to Avoid Them
Combining Multiple Specimens in One Jar
Multiple tissue samples from different sites end up in a single container.
You lose billable units instantly. Three sites in one jar = one billable unit.
How to Avoid: Train staff to use separate, labeled containers for each specimen. Audit submission habits monthly.
Using the Wrong Modifier
Billing globally when you only did the professional or technical Component.
This causes claim denials or underpayment.
How to Avoid: Confirm service type before billing. Use modifier 26 for interpretation only, modifier TC for lab work only, and no modifier for global billing.
Wrong ICD-10 Codes
ICD-10 Codes don’t match the documented reason for the biopsy.
Medical necessity denials occur from payers.
How to Avoid: Always link the ICD-10 code directly to the clinical reason in the provider’s notes. Use payer-specific LCD/NCD guidelines for covered diagnoses.
Incomplete Pathology Reports
Missing details like specimen site, clinical history, or pathology findings cause rejections and delayed payments.
How to Avoid: Implement a standardized pathology report template that includes all required elements.
Not Reconciling Pathology Logs with Claims
Some specimens are processed but never billed, which causes lost revenue that goes unnoticed until it’s too late.
How to Avoid: Match pathology lab logs against billed claims weekly. Any mismatch should be corrected before the end of the month.
FAQs
Can I bill 88305 for Pap smears or fluids?
No. CPT 88305 is only for surgical pathology on actual tissue specimens. Pap smears, urine, and other body fluids are billed under cytology codes like 88112 or 88175.
Can both the surgeon and pathologist bill 88305?
No. Only one claim per specimen is allowed. In most cases, the pathologist’s group or the lab performing the analysis bills 88305, not the surgeon.
One jar with two sites — how many units?
Just one. Even if the jar contains tissue from two different sites, payers count it as one specimen because it’s in a single container. That’s why separate jars protect revenue.
Do more slides mean more units?
No. One specimen can produce multiple slides for review, but you still bill only once. Billing is based on specimens, not on slide counts.
Can I bill 88305 for any tissue type?
No. CPT guidelines list the exact tissue types covered, such as skin, GI biopsies, endometrium, prostate, and single lymph nodes. Using it for unlisted tissues will lead to denials.
How ANR Billing Helps You Capture Every Dollar
We see CPT 88305 mistakes in practice almost every week.
Sometimes it’s a missing modifier that costs you $90–$120 per unit.
Other times, the ICD-10 code doesn’t match the pathology findings, leading to denials.
And yes, one of the most significant money leaks is combining multiple specimens into a single jar.
That can cost you $150–$250 in lost revenue instantly.
Our team works differently. We:
- Audit your pathology logs against claims so nothing gets missed.
- Catch modifier and coding errors before they go out.
- Match ICD-10 codes to payer medical necessity rules.
- Flag and fix any specimen-handling habits that shrink your reimbursement.
You focus on the clinical work.
We make sure you get paid for every unit you earned — no exceptions.
Let’s stop hidden revenue leaks before your following pathology report hits the lab.
Call ANR Billing today
