How much does Medicare pay for CPT 88331?

Medicare allowed an average of $72.30 per service and paid $57.00 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $227.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 88331?

Pathology examination of specimen during surgery, first tissue block. It was billed 264,895 times to 152,547 Medicare beneficiaries by 4,358 providers in 2024.

Does 88331 pay differently in an office than a hospital?

Yes. The allowed amount averaged $92.53 in an office setting and $59.64 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 88331 most?

Pathology, with 176,601 services from 3,756 clinicians. Next are Dermatology, Clinical Laboratory, Micrographic Dermatologic Surgery.

CPT 88331

Pathology examination of specimen during surgery, first tissue block

$72.30Medicare-allowed amount per service, averaged across 264,895 services

Providers submitted

$227.42

Asking price, not received

Medicare allowed

$72.30

The fee schedule figure

Medicare paid

$57.00

Balance is patient coinsurance

Providers submitted an average of $227.42 for this code and Medicare allowed $72.30 — 3.1× 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 $57.00 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $92.53
Hospital / facility: $59.64

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. 101,963 services were billed in an office setting and 162,932 in a facility.

Services: 264,895
Beneficiaries: 152,547
Providers billing it: 4,358
Total allowed: $19,151,909

What Medicare pays for CPT 88331

Across 264,895 services billed by 4,358 providers to 152,547 beneficiaries, Medicare allowed an average of $72.30 per service. That is 1.7 services per beneficiary, so this is a code patients typically receive more than once. 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 88331

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	176,601	99,441	$62.17	3,756
Dermatology	59,446	35,552	$96.30	405
Clinical Laboratory	15,292	8,719	$75.44	92
Micrographic Dermatologic Surgery	12,247	8,012	$98.72	87
Physician Assistant	288	163	$81.66	1
Gastroenterology	249	161	$42.47	1
Maxillofacial Surgery	126	69	$64.96	1
Undefined Physician type	123	112	$102.39	3
Dentist	117	55	$49.74	1
Diagnostic Radiology	116	77	$55.93	4
Oral and Maxillofacial Pathology	79	45	$60.14	1
Plastic and Reconstructive Surgery	74	41	$59.74	1
Ophthalmology	50	33	$61.49	1
Emergency Medicine	26	20	$61.25	1
General Practice	26	20	$60.65	1

88331 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
Florida	37,620	$79.32	$62.94	336
Texas	21,367	$76.03	$59.64	345
California	20,386	$76.72	$55.13	419
Arkansas	14,108	$84.44	$70.07	56
New York	11,522	$69.01	$50.80	269
Pennsylvania	10,091	$68.24	$53.50	178
Virginia	9,054	$85.59	$60.63	113
Minnesota	9,002	$63.85	$48.91	93
Tennessee	8,760	$80.10	$64.93	100
Ohio	8,229	$60.88	$49.59	170
Massachusetts	8,204	$68.46	$50.55	152
Illinois	7,320	$64.82	$50.74	174
Arizona	7,014	$68.69	$54.67	116
Maryland	6,778	$71.15	$53.60	106
North Carolina	5,921	$69.08	$57.12	110
Georgia	5,669	$71.96	$59.34	110
South Carolina	5,557	$71.87	$60.12	84
New Jersey	4,999	$67.47	$49.89	100
Alabama	4,455	$73.53	$62.29	64
Indiana	4,302	$65.87	$53.73	93
Iowa	4,009	$62.10	$50.24	69
Washington	3,791	$67.41	$50.55	94
Kentucky	3,590	$67.37	$55.65	74
Delaware	3,523	$88.68	$71.66	25
Louisiana	3,511	$57.25	$47.04	64
Missouri	3,478	$60.42	$48.73	82
Colorado	3,012	$64.53	$49.90	73
Wisconsin	2,853	$65.50	$51.31	69
Michigan	2,703	$60.24	$48.11	86
Kansas	2,453	$60.58	$49.67	56
Oregon	2,180	$62.76	$49.37	37
Utah	2,138	$66.59	$53.39	45
Nebraska	1,962	$62.27	$51.00	39
Oklahoma	1,851	$63.04	$51.61	43
Mississippi	1,662	$63.94	$53.39	37
Connecticut	1,231	$62.17	$46.79	42
New Mexico	1,108	$76.76	$61.76	20
South Dakota	1,050	$59.48	$47.39	17
Hawaii	1,027	$82.85	$60.66	13
Idaho	968	$77.87	$65.01	14
West Virginia	956	$62.60	$51.97	25
Nevada	929	$69.86	$55.05	28
New Hampshire	801	$60.56	$47.18	21
Maine	754	$53.44	$43.68	15
Montana	708	$68.15	$54.35	19
District of Columbia	707	$64.63	$47.47	20
Alaska	476	$78.08	$46.71	7
North Dakota	395	$58.39	$46.13	12
Rhode Island	261	$63.67	$48.53	10
Vermont	240	$67.49	$53.26	8
ZZ	107	$63.39	$46.63	2
Wyoming	103	$82.76	$68.03	4

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
88350Antibody evaluation$59.99
88344Special stained specimen slides to examine tissue$100.56
88374Microscopic genetic analysis of tissue$108.04

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.