How much does Medicare pay for CPT 88364?

Medicare allowed an average of $58.96 per service and paid $46.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $171.71, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 88364?

Genetic sequencing localization, each additional procedure. It was billed 35,291 times to 25,059 Medicare beneficiaries by 675 providers in 2024.

Does 88364 pay differently in an office than a hospital?

Yes. The allowed amount averaged $90.36 in an office setting and $32.86 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 88364 most?

Pathology, with 22,294 services from 600 clinicians. Next are Clinical Laboratory, Dermatology, Dentist.

CPT 88364

Genetic sequencing localization, each additional procedure

$58.96Medicare-allowed amount per service, averaged across 35,291 services

Providers submitted

$171.71

Asking price, not received

Medicare allowed

$58.96

The fee schedule figure

Medicare paid

$46.93

Balance is patient coinsurance

Providers submitted an average of $171.71 for this code and Medicare allowed $58.96 — 2.9× 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 $46.93 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $90.36
Hospital / facility: $32.86

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. 16,017 services were billed in an office setting and 19,274 in a facility.

Services: 35,291
Beneficiaries: 25,059
Providers billing it: 675
Total allowed: $2,080,757

What Medicare pays for CPT 88364

Across 35,291 services billed by 675 providers to 25,059 beneficiaries, Medicare allowed an average of $58.96 per service. That is 1.4 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 88364

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	22,294	16,817	$41.93	600
Clinical Laboratory	12,745	8,042	$88.73	64
Dermatology	146	115	$77.28	7
Dentist	34	30	$33.30	1
Hematology	31	20	$36.23	1
Undefined Physician type	27	22	$38.09	1
Ophthalmology	14	13	$32.80	1

88364 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	8,779	$56.70	$39.52	77
Florida	3,609	$75.24	$59.93	57
New Jersey	3,154	$102.11	$73.68	13
Texas	2,680	$71.18	$57.23	52
New York	2,277	$63.31	$44.85	62
Pennsylvania	1,554	$37.07	$28.99	47
Virginia	1,419	$39.34	$31.58	18
Ohio	1,301	$49.03	$41.23	33
Massachusetts	1,000	$52.10	$37.41	33
Illinois	945	$32.66	$25.52	31
Arizona	876	$57.70	$46.54	24
North Carolina	735	$31.32	$25.56	27
Connecticut	647	$91.28	$67.58	4
Missouri	573	$47.39	$38.31	15
Washington	514	$51.02	$38.96	13
South Carolina	455	$31.71	$25.50	14
Michigan	344	$32.00	$25.35	12
Indiana	342	$39.57	$33.04	7
Iowa	307	$33.14	$26.29	8
Maryland	305	$38.62	$29.36	13
Arkansas	305	$45.18	$39.26	9
Colorado	287	$37.03	$28.91	8
Oregon	284	$34.24	$25.52	9
Kansas	284	$41.44	$34.95	9
Nebraska	282	$41.60	$34.97	10
Minnesota	255	$49.45	$40.27	9
Louisiana	239	$31.57	$25.86	7
Wisconsin	234	$43.41	$35.91	6
Georgia	213	$67.28	$53.05	6
Delaware	113	$32.14	$25.28	2
New Mexico	106	$61.94	$51.32	3
Tennessee	104	$35.04	$28.66	5
North Dakota	101	$32.99	$26.37	3
Kentucky	100	$31.50	$25.48	5
Maine	88	$32.05	$25.55	3
Alabama	84	$66.78	$59.50	3
District of Columbia	63	$35.01	$25.46	2
Mississippi	61	$30.19	$25.60	3
Oklahoma	47	$63.88	$55.66	3
Montana	33	$31.63	$25.53	1
Nevada	31	$98.46	$78.48	1
Utah	31	$31.09	$25.46	1
New Hampshire	29	$32.54	$25.50	2
Rhode Island	23	$34.40	$25.41	1
South Dakota	22	$31.96	$25.50	1
West Virginia	22	$30.93	$25.40	1
Vermont	21	$31.13	$25.57	1
Hawaii	13	$30.73	$25.45	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.