2022 Final Medicare Fee Schedule: See impact to pathology

November 3, 2021

One year after Congress delayed planned fee schedule cuts due to the Covid-19 pandemic, it appears pathologists and other specialists are now going to experience payment reductions designed to offset boosts for evaluation and management (E/M) services in 2022, according to the Medicare Physician Fee Schedule (MPFS) Final Rule released Tuesday.

While the rule’s specialty impact table shows 0% changes in reimbursement for pathology and independent labs, all providers will experience a roughly 3.7% cut due to budget neutrality requirements triggered by RVU adjustments and the expiration of the 3.75% payment increase passed by Congress late last year to offset payment cuts in 2021. The final 2022 conversion factor is $33.59, a decrease of $1.30 from the 2021 conversion factor of $34.89.

However, the College of American Pathologists was successful in delaying a proposed additional 1% reduction to pathology services that would have been triggered by an update to practice expense clinical labor rates.

New consult codes finalized

However, much of that small cut for pathology is attributable to the decision to revamp the existing pathology consultation codes, 80500 and 80502. Taking their place will be four new codes (80503-88506), which describe physician pathology clinical consultation services provided at the request of another physician or qualified health care professional at the same or another facility or institution.

The distinction among the new code family involves a degree of complexity and/or time of service, broken down by 20-minute increments each for codes 80503, 80504, and 80505, along with an add-on code 80506 reflecting additional 15–30-minutes above that spent on CPT 80505.

Pathology clinical consultation services may be reported when the following criteria have been met:

  • The pathologist renders a pathology clinical consultation at the request of a physician or qualified healthcare professional at the same or another institution.
  • The pathology clinical consultation request is in relation to pathology and laboratory findings or other relevant clinical or diagnostic information requiring additional medical interpretative judgment.

Below is a sampling of several popular pathology codes set to see reductions in 2022:

CPT CodeServiceCurrent 2021Final 2022% Change 21-22
80503Path clinical consult sf 5-20NEW$25.87N/A
80504Path clinical consult mod 21-40NEW$51.74N/A
80505Path clinical consult high 41-60NEW$93.74N/A
80506Path clinical consult prolonged svcNEW$42.00N/A
88112 – GlobalCytopath cell enhance tech$67.69$65.52-3.2%
88112 – TCCytopath cell enhance tech$39.78$38.64-2.9%
88112 – 26Cytopath cell enhance tech$27.91$26.88-3.7%
88120 – GlobalCytp urne 3-5 probes ea spec$632.96$612.16-3.3%
88120 – TCCytp urne 3-5 probes ea spec$574.69$555.72-3.3%
88120 – 26Cytp urne 3-5 probes ea spec$58.27$56.45-3.1%
88121 – GlobalCytp urine 3-5 probes cmptr$456.75$431.07-5.6%
88121 – TCCytp urine 3-5 probes cmptr$408.25$384.36-5.9%
88121 – 26Cytp urine 3-5 probes cmptr$48.50$46.70-3.7%
88184Flowcytometry/ 1st marker$69.79$67.20-3.7%
88185Flowcytometry/ additional marker$23.03$21.50-6.6%
88187Flowcytometry/read 2-8$36.64$34.94-4.6%
88188Flowcytometry/read 9-15$62.81$61.15-2.6%
88189Flowcytometry/ read 16+$85.14$81.98-3.7%
88305 – GlobalTissue exam by pathologist$71.53$69.88-2.3%
88305 – TCTissue exam by pathologist$33.85$33.60-0.7%
88305 – 26Tissue exam by pathologist$37.68$36.29-3.7%
88307 – Global Level V, tissue exam by pathologist$290.31$282.23-2.8%
88307 – TCLevel V, tissue exam by pathologist$206.92$202.26-2.3%
88307 – 26Level V, tissue exam by pathologist$83.39$79.96-4.1%
88309 – GlobalTissue exam by pathologist$441.75$428.71-3.0%
88309 – TCTissue exam by pathologist$294.85$288.27-2.2%
88309 – 26Tissue exam by pathologist$146.90$140.44-4.4%
88312 – GlobalSpecial stains group 1$113.05$111.21-1.6%
88312 – TCSpecial stains group 1$86.19$85.68-0.6%
88312 – 26Special stains group 1$26.87$25.53-5.0%
88313 – GlobalSpecial stains group 2$81.65$79.96-2.1%
88313 – TCSpecial stains group 2$69.44$68.20-1.8%
88313 – 26Special stains group 2$12.21$11.76-3.7%
88341 – GlobalImmunohistochemistry (add stain)$93.86$87.02-7.3%
88341 – TCImmunohistochemistry (add stain)$65.25$59.80-8.4%
88341 – 26Immunohistochemistry (add stain)$28.61$27.21-4.9%
88342 – GlobalImmunohisto antibody 1st stain$106.08$99.45-6.3%
88342 – TCImmunohisto antibody 1st stain$70.83$65.85-7.0%
88342 – 26Immunohisto antibody 1st stain$35.24$33.60-4.7%
88367 – GlobalInsitu hybridization auto$115.85$111.55-3.7%
88367 – TCInsitu hybridization auto$82.00$78.96-3.7%
88367 – 26Insitu hybridization auto$33.85$32.59-3.7%
88368 – GlobalInsitu hybridization manual$137.13$134.06-2.2%
88368 – TCInsitu hybridization manual$95.61$94.08-1.6%
88368 – 26Insitu hybridization manual$41.52$39.98-3.7%
G0416 – GlobalProstate biopsy$354.16$348.08-1.7%
G0416 – TCProstate biopsy$175.51$175.720.1%
G0416 – 26Prostate biopsy$178.65$172.36-3.5%
G0452 – 26Molecular path interp$46.41$44.69-3.7%
P3001Screening pap smear by phys$21.98$21.84-0.6%
Credit: CAP

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