How much does Medicare pay for CPT 88363?

Medicare allowed an average of $19.36 per service and paid $15.34 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $94.88, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 88363?

Examination of archival tissue for genetic analysis. It was billed 42,073 times to 40,256 Medicare beneficiaries by 1,257 providers in 2024.

Does 88363 pay differently in an office than a hospital?

Yes. The allowed amount averaged $22.61 in an office setting and $18.51 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 88363 most?

Pathology, with 38,793 services from 1,218 clinicians. Next are Clinical Laboratory, Dermatology, Diagnostic Radiology.

CPT 88363

Examination of archival tissue for genetic analysis

$19.36Medicare-allowed amount per service, averaged across 42,073 services

Providers submitted

$94.88

Asking price, not received

Medicare allowed

$19.36

The fee schedule figure

Medicare paid

$15.34

Balance is patient coinsurance

Providers submitted an average of $94.88 for this code and Medicare allowed $19.36 — 4.9× 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 $15.34 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $22.61
Hospital / facility: $18.51

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. 8,715 services were billed in an office setting and 33,358 in a facility.

Services: 42,073
Beneficiaries: 40,256
Providers billing it: 1,257
Total allowed: $814,533

What Medicare pays for CPT 88363

Across 42,073 services billed by 1,257 providers to 40,256 beneficiaries, Medicare allowed an average of $19.36 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 88363

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	38,793	37,285	$19.21	1,218
Clinical Laboratory	3,238	2,929	$21.15	36
Dermatology	28	28	$23.26	2
Diagnostic Radiology	14	14	$18.64	1

88363 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	4,730	$20.92	$15.02	149
Texas	4,041	$18.58	$14.32	92
Florida	3,183	$20.59	$15.77	82
Illinois	2,907	$19.63	$15.25	63
Georgia	2,328	$18.67	$15.12	68
Missouri	2,036	$18.37	$14.61	72
Ohio	1,730	$17.91	$14.40	74
Virginia	1,698	$18.01	$14.37	48
Pennsylvania	1,633	$18.76	$14.19	56
North Carolina	1,468	$19.22	$15.64	35
Maryland	1,315	$19.68	$14.54	37
Arizona	1,086	$19.07	$15.16	20
New York	1,000	$22.05	$15.60	37
Indiana	932	$18.25	$19.08	19
Michigan	863	$18.71	$14.80	45
Louisiana	832	$19.62	$16.14	16
Arkansas	746	$19.84	$16.36	18
Nebraska	726	$18.33	$15.04	19
Washington	696	$21.79	$16.93	19
Massachusetts	666	$19.54	$14.42	23
South Carolina	648	$18.09	$14.66	16
Wisconsin	641	$17.63	$14.60	33
Nevada	576	$21.25	$17.20	6
Alabama	546	$18.25	$15.31	16
Iowa	512	$18.09	$14.69	18
Kentucky	483	$18.09	$18.03	21
Oklahoma	451	$18.85	$15.52	12
Tennessee	438	$20.59	$16.67	14
Minnesota	359	$19.61	$15.90	20
Mississippi	354	$18.55	$15.13	13
Utah	350	$18.27	$14.38	14
Colorado	314	$19.06	$14.69	15
West Virginia	265	$20.40	$15.92	9
New Jersey	253	$19.68	$14.29	12
Alaska	212	$24.57	$14.52	5
Montana	191	$18.06	$14.68	3
Connecticut	173	$20.05	$14.89	9
New Mexico	144	$18.78	$15.28	4
Idaho	132	$18.13	$14.74	5
Oregon	99	$19.93	$15.52	5
Kansas	92	$19.11	$16.24	5
District of Columbia	67	$19.81	$14.57	3
Delaware	59	$18.58	$14.10	2
New Hampshire	55	$18.51	$14.32	3
North Dakota	43	$17.99	$13.92	2

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.