Be Prepared: Commercial Payors May Look to Slash Pathology Reimbursement

If your practice provides pathology services, prepare yourself: Commercial carriers may attempt to significantly reduce their reimbursement rates for such services in 2013. In its final 2013 physician fee schedule, as the College of American Pathologists notes, CMS lowered the technical component of surgical pathology CPT code 88305 by 52 percent, beginning Jan. 1. While it raised the professional component by 2 percent, this revaluation alters the global payment for the code, which will decrease by 33 percent as a result.

Although this change is specific to Medicare payments, since some commercial payors set their fees at a percentage of Medicare, they may seek adjust their fee schedule to more closely align with Medicare’s 2013 schedule and cut your pathology reimbursement. Significant changes in a practice’s fee schedule are not uncommon, which is why healthy practices routinely undergo a payor mix and fee schedule examination from medical billing and coding service companies. A medical billing company can assist you in making the best payor mix determinations for your practice and help you to minimize the negative impact of potential reimbursement cuts.


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