Pathology billing for pathology groups and practices: surgical pathology billed per specimen, special stains and immunohistochemistry, frozen sections, cytology and molecular tests, split between professional and technical components by where each specimen came from.
Pathology is billed per specimen, per stain and per component. Each specimen is coded to its level of examination, each stain and antibody is counted, the professional and technical parts are billed by whoever performed them, and every unpaid line is followed until it is resolved.
$80M
in improper Medicare payments to pathology in CMS’s 2025 review, an 8.9% improper payment rate
99.8%
of those pathology errors were missing or insufficient documentation
A single case can produce many lines: a surgical pathology code for each specimen, a special stain or antibody for each block, a frozen section during surgery and a molecular test weeks later. Where the specimen came from decides who bills which part. For a hospital patient, the technical work generally belongs to the hospital, and the pathology group bills only the professional component.
The specimen count and the source decide the claim. That is why we check every case against its requisition and report for the number of specimens, the stains and the setting before the claim goes out.
Pathology claims fail on counts, components and documentation. Each part of a case has its own rules. Each card shows where the claim fails and what we change.
Pays forGross and microscopic examination of each specimen, at the level that matches the tissue.
Where it breaks
What we do
Pays forSpecial stains, immunohistochemistry and frozen sections, per specimen and per block.
Where it breaks
What we do
Pays forProfessional and technical components, and molecular tests billed by the lab that performs them.
Where it breaks
What we do
Most pathology services have a technical component, the processing of the tissue and the slides, and a professional component, the pathologist’s reading and report. When a specimen comes from a physician’s office or an ambulatory surgery center and your lab does both, the service is billed globally. When it comes from a hospital inpatient or outpatient, Medicare generally pays the technical component to the hospital, and the pathology group bills only the professional component with modifier 26.
The date of service matters too. Under 42 CFR 414.510, the date of service is normally the date the specimen was collected, which can tie a test to a hospital stay. Narrow exceptions move it to the date the test was performed, such as a test ordered at least 14 days after discharge, or certain molecular pathology tests on specimens from hospital outpatients, and in those cases the lab bills Medicare directly.
What we do: for each case, we check where the specimen came from, whether the patient was a hospital patient on the collection date, and when the test was ordered, then bill global, professional or the test date the rules call for.
Pathology codes count specimens, antibodies and blocks. These are the ones that decide most claims, with what payers check on each.
| Code | What it covers | What payers look for |
|---|---|---|
| 88300 to 88309 | Surgical pathology, levels I to VI | One unit per separately identified specimen, at the level for that tissue. |
| 88305 | Surgical pathology, level IV | The most billed level; units match the specimens in the report. |
| G0416 | Prostate needle biopsy pathology, any number of specimens | Medicare: billed once instead of 88305 per core. |
| 883428834188344 | Immunohistochemistry: first antibody, each additional, multiplex | Per specimen and antibody, with the reason for the stain. |
| 8831288313 | Special stains, for organisms and other | Per specimen, with the stain named in the report. |
| 883318833288329 | Frozen sections and intraoperative consultation | Per block for frozen sections; 88329 when no frozen section was made. |
| 8811288173 | Cytology and fine needle aspirate interpretation | The specimen type and the interpretation documented. |
| 81479 | Unlisted molecular pathology | The test identifier MolDX contractors require, and the coverage policy. |
The pathologist's reading when the hospital or another lab did the technical work.
The processing, when another pathologist reads the slides.
A stain or exam on a separate specimen that edits would otherwise bundle. Our modifier 59 guide
A test sent to an outside lab and billed by the referring lab.
A repeat test on the same day to get a later result, not a rerun.
Medicare: a test that may not be covered, with a signed notice.
Sources: Medicare Claims Processing Manual, chapter 12, section 60, and chapter 16; Medicare NCCI Policy Manual, chapter X (pathology and laboratory); 42 CFR 414.510. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, specimen counts, stain and antibody coding, component splits and date of service, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list each facility that sends you specimens and how requisitions arrive, and agree how escalations work. Most practices are live within one to two weeks.
Specimens, stains and readings are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, specimen counts, components and dates of service checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Pathology revenue comes from many lines per case, each worth a modest amount. Under a fee based on collections, our pay depends on getting every specimen, stain and reading paid, not just on sending claims.
Summit Billing Solutions charges between 3% and 9% of monthly collections. Your rate reflects case volume, the share of hospital versus outpatient specimens, molecular testing and the state of the receivables, which we see in the free account review.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, specimen counts, stain and antibody coding, component splits and dates of service, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
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