Pathology Exam of Biopsy Tissue Cost
Tissue exam by pathologist
$88Hospital outpatient total2026 Medicare, physician + facilityUnder 2026 Medicare rates, a pathology exam of biopsy tissue costs up to about $88 in total at a hospital outpatient department, counting both the physician and the facility. Outside a hospital, one global fee of about $70 covers the whole test, and a ZIP code adjusts every figure to your area.
- ✓Your ZIP's wage-adjusted hospital and surgery center rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
What the whole procedure costs
The office rate above is what an imaging center, lab or office is paid for the whole test. In a hospital, the facility bills its own fee and the physician bills only the reading. These are 2026 national Medicare amounts.
Medicare may pay the facility separately for this code or package it into another service on the same day, so treat the facility share as an upper bound. For a test like this the physician in a hospital bills only the reading (the professional component); outside a hospital one global fee covers the whole test, shown in the office rate above. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough: no account, no insurance card.
What pathology exam of biopsy tissue costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
For example 90001.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery center rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $35.07.
How CMS prices CPT 88305
Work is about 35% of the office total RVU; practice expense is about 64%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $70.14. Hospital (facility) physician rate: $35.07.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible, about $14 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
Pathology Exam of Biopsy Tissue cost by state
2026 Medicare non-hospital rate for CPT 88305, averaged across each state's localities. Open a state for its locality table and full cost breakdown.
What Is Pathology Exam of Biopsy Tissue?
CPT 88305 covers a pathologist examining tissue from a biopsy or minor surgery under a microscope: a skin biopsy, a polyp removed during a colonoscopy, or a breast or prostate core, for example. The lab processes the tissue into stained glass slides, and a pathologist, often a dermatopathologist for skin samples, reads them and writes the diagnosis report. It is one of the most frequently billed pathology codes, and it is billed per specimen, so several biopsies from one procedure often produce several charges.
What Affects the Cost
- –Each separately submitted specimen is billed as its own unit, so three polyps sent in three containers can mean three charges.
- –Special stains or immunohistochemistry, used when the diagnosis is not clear on routine slides, are billed with additional codes such as 88312 or 88342.
- –An independent lab usually bills one global fee, while a hospital lab bills the tissue processing on its own claim and the pathologist bills the reading.
- –Out-of-network lab bills are a common surprise, because patients rarely choose the lab that receives their biopsy.
- –An outside second opinion on the slides is billed with separate consultation codes.
How It Is Billed
The code has two parts: the technical component for processing the tissue and making the slides, and the professional component (modifier 26) for the pathologist's reading and report. An independent lab that does both bills one global amount. 88305 is the level IV surgical pathology code and covers a defined list of specimen types; simpler or more complex specimens use neighboring codes such as 88304 or 88307, which is why two biopsies can be priced differently.
Insurance & Coverage Notes
Pathology is covered as part of the diagnostic workup when the biopsy itself is covered, and it does not need its own prior authorization. The bill often arrives weeks later from a lab or pathology group you never dealt with directly. If the biopsy was done at an in-network hospital or surgery center, the No Surprises Act protects you from many out-of-network bills for ancillary services like pathology. Under Original Medicare, surgical pathology is paid under the Physician Fee Schedule, so the Part B deductible and 20 percent coinsurance apply, unlike most routine blood tests.
Questions to Ask Before Booking
- 1.Which lab will the tissue go to, and is it in my network?
- 2.How many specimens will be sent, and will each one be billed?
- 3.Will special stains or extra tests be run, and would you tell me first?
- 4.Is a dermatopathologist or other subspecialist reading the slides, and are they in network?
- 5.If I get a bill from a lab I did not choose, who do I contact to have it reprocessed?
Pathology Exam of Biopsy Tissue (CPT 88305): questions
Under 2026 Medicare rates, a pathology exam of biopsy tissue costs up to about $88 in total at a hospital outpatient department, counting both the physician and the facility. Outside a hospital, one global fee of about $70 covers the whole test, and a ZIP code adjusts every figure to your area.
Outside a hospital, one global fee pays for the equipment, the staff and the doctor's reading, so the office or imaging center rate for CPT 88305 is $70.14. In a hospital the physician bills only the reading, about $35.07, and the hospital is paid for the rest on its own claim.
CPT 88305 covers a pathologist examining tissue from a biopsy or minor surgery under a microscope: a skin biopsy, a polyp removed during a colonoscopy, or a breast or prostate core, for example. The lab processes the tissue into stained glass slides, and a pathologist, often a dermatopathologist for skin samples, reads them and writes the diagnosis report. It is one of the most frequently billed pathology codes, and it is billed per specimen, so several biopsies from one procedure often produce several charges. CMS bills it as “Tissue exam by pathologist.”
It depends on the setting. At an independent imaging center, lab or office, $70.14 is Medicare's full national rate, covering the test and the reading. In a hospital outpatient department the physician is paid only for the reading (about $35.07) and the hospital is paid separately, which takes the total to about $88. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.