2025 CPT code 88399
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgical Pathology Procedures - Unlisted surgical pathology procedure Pathology and Laboratory Procedures > Surgical Pathology Procedures Feed
Unlisted surgical pathology procedure.
Modifiers may apply depending on the circumstances of the service.Consult CPT guidelines and payer requirements for appropriate modifier use.
The medical necessity must be clearly established by demonstrating that the performed procedure is not adequately described by an existing CPT code. The documentation must justify both the procedure and the level of service.
The provider performs a surgical pathology procedure that is not represented by any of the standard and active CPT® codes available. The provider is responsible for complete and accurate documentation to support the use of 88399.
In simple words: This code is used when a surgeon performs a procedure that doesn't have a specific billing code.The doctor needs to provide detailed information to explain why this code is needed, which will help get payment for the service.
This code reports surgical pathology procedures not specified by other CPT codes (88300-88388).It is used when the physician's work does not match any existing code.Detailed documentation justifying the use of this unlisted code, including a comparison to similar coded procedures and the rationale for the selected level of service, is crucial for accurate billing and reimbursement.
Example 1: A surgeon removes a rare, atypical tumor.No existing CPT code fully encompasses the complexity of the pathology examination required. 88399 is used, with extensive documentation detailing the unique aspects of the case and justifying the level of service., A pathologist analyzes a complex tissue sample from an experimental surgical technique. The procedure requires highly specialized techniques and extensive microscopic analysis. The 88399 is chosen, supported by detailed notes outlining the unique examination and interpretation required., A specialized surgical procedure yields a unique specimen, requiring an analysis technique different from those described in existing CPT codes.88399 is reported, with a detailed explanation of the specialized technique and the complexity of its analysis in comparison to existing similar procedures.This requires thorough documentation to support the medical necessity.
Complete operative notes, detailed pathology report, microscopic images if applicable, and a comprehensive explanation comparing the work performed to similar coded procedures.A cover letter justifying the use of unlisted code is mandatory.
** Always consult the most current CPT codebook and payer guidelines for accurate billing and reimbursement.Accurate and comprehensive documentation is critical for proper payment.
- Revenue Code: T1G (LAB TESTS - OTHER (MEDICARE FEE SCHEDULE))
- RVU: The RVUs for 88399 vary significantly depending on the complexity of the procedure and payer's guidelines.The provider must justify the RVU assignment based on the documentation provided.
- Global Days : Not applicable. This is an unlisted procedure code, and global surgical days don't apply directly.The global period would depend on the specific unlisted procedure's nature.
- Payment Status: Active
- Modifier TC rule: The TC modifier is not applicable to this code since it represents a complete procedure, not just a technical component.
- Fee Schedule : Historical fee schedules for 88399 are unavailable as the reimbursement depends entirely on the specifics of the unlisted procedure and the payer's policies.
- Specialties:Pathology, Surgery
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center