Several pathology codes could see significant cuts under proposed Medicare fee schedule

July 26, 2016

The Centers for Medicare and Medicaid Services has proposed rate cuts for a large number of TC pathology codes in its proposal for the agency’s 2017 Medicare Physician Fee Schedule, a move the agency has justified primarily as a reflection of the reduced cost of supplies for these procedures.

The most significant proposed cuts would affect TC rates for 17 codes, with the most notable being a 15 percent reduction for 88305-TC ($29.34) that CMS has attributed to the decreased cost of utilizing eosin stain supplies rather than eosin solution. The other codes negatively affected by this adjustment include 88302, 88304, 88307, 88309, 88323, 88325, 88364, 88365, 88366, 88367, 88368, 88369, 88373, 88374, 88377 and G0416.

The only other major reduction is a 19 percent drop for 88184, 88185 and 88189, which pertain to flow cytometry.

Fortunately, the rates for professional components will remain largely unchanged.

Although there were very few rate hikes proposed, there were at least some notable concessions made. The most significant hike would boost global reimbursement for 88361 by 4 percent ($155.98), while also upping the code’s technical component by 7 percent ($94.80) and its professional portion by 1 percent ($61.18). Additionally, the professional portion of the G0416 prostate biopsy would see a 17 percent boost ($184.96)

Check out the chart below for a breakdown of the major proposed changes for several key pathology codes. Keep in mind that the conversion factor for 2016 is 35.8043, while the proposed factor for 2017 is 35.7751.

Comparing these rate adjustments against your lab’s current volume will be essential in determining how your revenue stands to be impacted, assuming the proposed rates remain relatively static in the finalized Medicare fee schedule that is expected to be released in October.

CMS is accepting public comment on its proposed fee schedule through Sept. 6. The new rates will then go into effect on Jan. 1, 2017.

CPT Code Description Proposed 2017 Current 2016 Percent Change
88112-Global Cytopath cell enhance tech 68.33 72.32 -6%
88112-26 Cytopath cell enhance tech 28.98 29.00 0%
88112-TC Cytopath cell enhance tech 39.35 43.32 -9%
88184-TC only Flow cytometry/1st marker 61.53 76.26 -19%
88185-TC only Flow cytometry/each additional marker 37.56 46.55 -19%
88189-TC only Flow cytometry, read 16+ 92.30 114.22 -19%
88305-Global Tissue exam by pathologist 69.05 74.11 -7%
88305-26 Tissue exam by pathologist 39.71 39.74 0%
88305-TC Tissue exam by pathologist 29.34 34.37 -15%
88307-Global Level V, tissue exam by pathologist 269.03 312.21 -14%
88307-26 Level V, tissue exam by pathologist 87.65 87.36 0%
88307-TC Level V, tissue exam by pathologist 181.38 224.85 -19%
88312-Global Special stains, group 1 98.74 98.82 0%
88312-26 Special stains, group 1 28.26 28.29 0%
88312-TC Special stains, group 1 70.48 70.53 0%
88313-Global Special stains; group 2 70.12 69.10 1%
88313-26 Special stains; group 2 12.52 12.53 0%
88313-TC Special stains; group 2 57.60 56.57 2%
88341-Global Immunohistochemistry (Additonal stain) 90.15 90.23 0%
88341-26 Immunohistochemistry (Additonal stain) 28.26 27.93 1%
88341-TC Immunohistochemistry (Additonal stain) 61.89 62.30 -1%
88342-Global Immunohistochemistry (1st stain) 107.68 107.41 0%
88342-26 Immunohistochemistry (1st stain) 37.21 37.24 0%
88342-TC Immunohistochemistry (1st stain) 70.48 70.18 0%
88361-Global Tumor immunohistochem/computer 155.98 149.66 4%
88361-26 Tumor immunohistochem/computer 61.18 60.87 1%
88361-TC Tumor immunohistochem/computer 94.80 88.79 7%
G0416-Global Prostate Biopsy 488.33 534.20 -9%
G0416-26 Prostate Biopsy 184.96 157.90 17%
G0416-TC Prostate Biopsy 303.37 376.30 -19%

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