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 Code | Service | Current 2021 | Final 2022 | % Change 21-22 |
| 80503 | Path clinical consult sf 5-20 | NEW | $25.87 | N/A |
| 80504 | Path clinical consult mod 21-40 | NEW | $51.74 | N/A |
| 80505 | Path clinical consult high 41-60 | NEW | $93.74 | N/A |
| 80506 | Path clinical consult prolonged svc | NEW | $42.00 | N/A |
| 88112 – Global | Cytopath cell enhance tech | $67.69 | $65.52 | -3.2% |
| 88112 – TC | Cytopath cell enhance tech | $39.78 | $38.64 | -2.9% |
| 88112 – 26 | Cytopath cell enhance tech | $27.91 | $26.88 | -3.7% |
| 88120 – Global | Cytp urne 3-5 probes ea spec | $632.96 | $612.16 | -3.3% |
| 88120 – TC | Cytp urne 3-5 probes ea spec | $574.69 | $555.72 | -3.3% |
| 88120 – 26 | Cytp urne 3-5 probes ea spec | $58.27 | $56.45 | -3.1% |
| 88121 – Global | Cytp urine 3-5 probes cmptr | $456.75 | $431.07 | -5.6% |
| 88121 – TC | Cytp urine 3-5 probes cmptr | $408.25 | $384.36 | -5.9% |
| 88121 – 26 | Cytp urine 3-5 probes cmptr | $48.50 | $46.70 | -3.7% |
| 88184 | Flowcytometry/ 1st marker | $69.79 | $67.20 | -3.7% |
| 88185 | Flowcytometry/ additional marker | $23.03 | $21.50 | -6.6% |
| 88187 | Flowcytometry/read 2-8 | $36.64 | $34.94 | -4.6% |
| 88188 | Flowcytometry/read 9-15 | $62.81 | $61.15 | -2.6% |
| 88189 | Flowcytometry/ read 16+ | $85.14 | $81.98 | -3.7% |
| 88305 – Global | Tissue exam by pathologist | $71.53 | $69.88 | -2.3% |
| 88305 – TC | Tissue exam by pathologist | $33.85 | $33.60 | -0.7% |
| 88305 – 26 | Tissue exam by pathologist | $37.68 | $36.29 | -3.7% |
| 88307 – Global | Level V, tissue exam by pathologist | $290.31 | $282.23 | -2.8% |
| 88307 – TC | Level V, tissue exam by pathologist | $206.92 | $202.26 | -2.3% |
| 88307 – 26 | Level V, tissue exam by pathologist | $83.39 | $79.96 | -4.1% |
| 88309 – Global | Tissue exam by pathologist | $441.75 | $428.71 | -3.0% |
| 88309 – TC | Tissue exam by pathologist | $294.85 | $288.27 | -2.2% |
| 88309 – 26 | Tissue exam by pathologist | $146.90 | $140.44 | -4.4% |
| 88312 – Global | Special stains group 1 | $113.05 | $111.21 | -1.6% |
| 88312 – TC | Special stains group 1 | $86.19 | $85.68 | -0.6% |
| 88312 – 26 | Special stains group 1 | $26.87 | $25.53 | -5.0% |
| 88313 – Global | Special stains group 2 | $81.65 | $79.96 | -2.1% |
| 88313 – TC | Special stains group 2 | $69.44 | $68.20 | -1.8% |
| 88313 – 26 | Special stains group 2 | $12.21 | $11.76 | -3.7% |
| 88341 – Global | Immunohistochemistry (add stain) | $93.86 | $87.02 | -7.3% |
| 88341 – TC | Immunohistochemistry (add stain) | $65.25 | $59.80 | -8.4% |
| 88341 – 26 | Immunohistochemistry (add stain) | $28.61 | $27.21 | -4.9% |
| 88342 – Global | Immunohisto antibody 1st stain | $106.08 | $99.45 | -6.3% |
| 88342 – TC | Immunohisto antibody 1st stain | $70.83 | $65.85 | -7.0% |
| 88342 – 26 | Immunohisto antibody 1st stain | $35.24 | $33.60 | -4.7% |
| 88367 – Global | Insitu hybridization auto | $115.85 | $111.55 | -3.7% |
| 88367 – TC | Insitu hybridization auto | $82.00 | $78.96 | -3.7% |
| 88367 – 26 | Insitu hybridization auto | $33.85 | $32.59 | -3.7% |
| 88368 – Global | Insitu hybridization manual | $137.13 | $134.06 | -2.2% |
| 88368 – TC | Insitu hybridization manual | $95.61 | $94.08 | -1.6% |
| 88368 – 26 | Insitu hybridization manual | $41.52 | $39.98 | -3.7% |
| G0416 – Global | Prostate biopsy | $354.16 | $348.08 | -1.7% |
| G0416 – TC | Prostate biopsy | $175.51 | $175.72 | 0.1% |
| G0416 – 26 | Prostate biopsy | $178.65 | $172.36 | -3.5% |
| G0452 – 26 | Molecular path interp | $46.41 | $44.69 | -3.7% |
| P3001 | Screening pap smear by phys | $21.98 | $21.84 | -0.6% |
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