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2022 Final Medicare Fee Schedule: See impact to pathology

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%
Credit: CAP

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