How much does Medicare pay for CPT 88321?

Medicare allowed an average of $89.21 per service and paid $69.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $332.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 88321?

Surgical pathology consultation and report on referred slides prepared elsewhere. It was billed 145,780 times to 139,495 Medicare beneficiaries by 2,413 providers in 2024.

Does 88321 pay differently in an office than a hospital?

Yes. The allowed amount averaged $98.34 in an office setting and $83.38 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 88321 most?

Pathology, with 108,419 services from 2,185 clinicians. Next are Clinical Laboratory, Dermatology, Micrographic Dermatologic Surgery.

CPT 88321

Surgical pathology consultation and report on referred slides prepared elsewhere

$89.21Medicare-allowed amount per service, averaged across 145,780 services

Providers submitted

$332.54

Asking price, not received

Medicare allowed

$89.21

The fee schedule figure

Medicare paid

$69.05

Balance is patient coinsurance

Providers submitted an average of $332.54 for this code and Medicare allowed $89.21 — 3.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $69.05 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $98.34
Hospital / facility: $83.38

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 56,839 services were billed in an office setting and 88,941 in a facility.

Services: 145,780
Beneficiaries: 139,495
Providers billing it: 2,413
Total allowed: $13,005,034

What Medicare pays for CPT 88321

Across 145,780 services billed by 2,413 providers to 139,495 beneficiaries, Medicare allowed an average of $89.21 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 88321

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	108,419	105,845	$86.55	2,185
Clinical Laboratory	19,424	18,468	$98.03	103
Dermatology	16,669	13,995	$95.50	107
Micrographic Dermatologic Surgery	665	614	$107.14	2
Undefined Physician type	264	242	$93.90	1
Hematology-Oncology	71	66	$79.03	1
Ophthalmology	55	55	$85.48	2
Maxillofacial Surgery	53	52	$107.92	2
Dentist	38	38	$79.50	2
Hematology	37	36	$79.77	2
Neurology	26	26	$97.87	2
Oral Surgery (Dentist only)	25	25	$97.57	2
Family Practice	22	21	$78.75	1
Obstetrics & Gynecology	12	12	$81.41	1

88321 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	30,414	$98.86	$69.41	256
New York	17,027	$90.17	$64.35	244
Texas	11,767	$82.88	$61.89	129
Florida	11,579	$84.80	$65.40	172
Massachusetts	9,276	$87.68	$62.98	188
Pennsylvania	5,940	$83.48	$62.84	138
Maryland	5,460	$96.32	$71.22	51
Michigan	5,055	$81.57	$61.58	96
Ohio	4,870	$86.26	$68.63	107
Washington	4,322	$92.79	$65.41	71
Illinois	3,996	$88.53	$65.01	87
Minnesota	3,298	$93.64	$71.16	80
Tennessee	2,817	$81.63	$65.27	71
North Carolina	2,753	$81.21	$65.92	81
Virginia	2,687	$83.83	$65.11	50
Missouri	2,678	$87.60	$67.87	35
Arizona	2,090	$90.98	$69.32	47
Connecticut	2,070	$97.82	$71.83	14
Kentucky	1,507	$81.67	$61.76	34
South Carolina	1,382	$80.39	$64.79	30
Colorado	1,334	$94.81	$71.97	14
Utah	1,248	$86.45	$67.18	26
Iowa	1,244	$81.39	$66.26	34
Kansas	1,241	$78.03	$61.71	28
Oregon	1,189	$88.09	$63.74	29
Georgia	1,065	$82.61	$64.94	38
Wisconsin	1,045	$80.14	$63.35	42
Indiana	1,022	$81.32	$68.83	27
New Jersey	957	$88.04	$64.36	45
Nebraska	726	$75.68	$60.46	18
Arkansas	689	$77.15	$63.94	23
South Dakota	416	$83.89	$61.66	5
Alabama	395	$76.67	$62.67	14
New Hampshire	388	$81.09	$60.62	21
New Mexico	307	$86.47	$67.22	8
Vermont	231	$73.15	$60.96	13
ZZ	229	$88.02	$65.34	2
West Virginia	196	$80.03	$60.72	7
Rhode Island	170	$87.05	$62.85	3
Louisiana	169	$86.66	$71.39	6
Mississippi	118	$75.36	$62.27	5
District of Columbia	91	$88.88	$61.06	5
Maine	79	$80.32	$61.58	5
Nevada	70	$89.58	$69.86	4
Oklahoma	54	$80.48	$65.78	4
Idaho	28	$83.59	$62.52	2
Alaska	27	$105.48	$64.11	1
North Dakota	27	$92.66	$69.34	1
Hawaii	26	$95.66	$72.39	1
Puerto Rico	11	$81.89	$63.40	1

Related codes

88305Pathology examination of tissue$50.75
88341Special stained specimen slides to examine tissue$40.33
88342Special stained specimen slides to examine tissue$58.61
88313Special stained specimen slides to examine tissue including interpreta$43.56
88312Special stained specimen slides to identify organisms including interp$75.82
88307Pathology examination of tissue$84.93
88304Pathology examination of tissue$21.25
88360Microscopic genetic analysis of tumor$59.67
88311Preparation of tissue for examination by removing any calcium present$12.68
88331Pathology examination of specimen during surgery$72.30
88350Antibody evaluation$59.99
88344Special stained specimen slides to examine tissue$100.56

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.