How much does Medicare pay for CPT 88365?

Medicare allowed an average of $81.14 per service and paid $64.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $251.64, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 88365?

Genetic sequencing localization, initial procedure. It was billed 53,545 times to 45,280 Medicare beneficiaries by 1,210 providers in 2024.

Does 88365 pay differently in an office than a hospital?

Yes. The allowed amount averaged $141.37 in an office setting and $41.79 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 88365 most?

Pathology, with 34,280 services from 1,090 clinicians. Next are Clinical Laboratory, Dermatology, Hematology.

CPT 88365

Genetic sequencing localization, initial procedure

$81.14Medicare-allowed amount per service, averaged across 53,545 services

Providers submitted

$251.64

Asking price, not received

Medicare allowed

$81.14

The fee schedule figure

Medicare paid

$64.60

Balance is patient coinsurance

Providers submitted an average of $251.64 for this code and Medicare allowed $81.14 — 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 $64.60 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $141.37
Hospital / facility: $41.79

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. 21,162 services were billed in an office setting and 32,383 in a facility.

Services: 53,545
Beneficiaries: 45,280
Providers billing it: 1,210
Total allowed: $4,344,641

What Medicare pays for CPT 88365

Across 53,545 services billed by 1,210 providers to 45,280 beneficiaries, Medicare allowed an average of $81.14 per service. That is 1.2 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 88365

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	34,280	30,248	$51.69	1,090
Clinical Laboratory	18,833	14,672	$135.04	101
Dermatology	218	182	$92.45	11
Hematology	75	52	$44.57	2
Dentist	51	47	$41.77	2
Undefined Physician type	46	40	$48.31	1
Ophthalmology	30	27	$42.59	2
Oral and Maxillofacial Pathology	12	12	$41.62	1

88365 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	13,449	$112.55	$74.22	165
Florida	4,678	$91.00	$72.35	83
Texas	3,986	$84.40	$69.02	90
New York	3,637	$77.36	$54.50	101
Arizona	2,925	$103.48	$84.81	34
Pennsylvania	2,543	$45.55	$35.61	75
Ohio	2,439	$61.49	$51.18	59
Massachusetts	1,992	$57.92	$42.01	63
New Jersey	1,822	$110.95	$79.85	24
Virginia	1,801	$56.27	$45.09	35
North Carolina	1,212	$48.00	$39.53	43
Illinois	1,150	$41.37	$32.24	43
Michigan	991	$40.49	$32.09	38
Missouri	891	$59.88	$48.21	27
Washington	804	$62.45	$47.93	25
Connecticut	714	$128.23	$94.83	8
Maryland	674	$76.41	$58.12	22
Minnesota	661	$65.87	$52.37	23
South Carolina	645	$40.05	$32.21	20
Tennessee	518	$53.78	$44.71	18
Indiana	486	$48.63	$40.81	12
Wisconsin	482	$49.53	$40.17	19
Arkansas	429	$54.72	$47.24	15
Colorado	419	$49.28	$38.46	14
Kansas	397	$50.94	$42.45	15
Iowa	386	$41.62	$33.11	11
Georgia	376	$74.91	$59.83	14
Nebraska	360	$50.17	$41.92	12
Oregon	355	$43.11	$32.31	11
Louisiana	319	$39.86	$32.60	9
Kentucky	283	$56.63	$47.96	12
Alabama	246	$71.53	$62.41	8
New Mexico	220	$70.38	$58.41	8
Oklahoma	158	$54.03	$45.77	9
North Dakota	134	$41.58	$33.57	4
Delaware	124	$40.67	$32.02	2
District of Columbia	107	$44.11	$32.28	4
Montana	104	$39.83	$32.25	5
Maine	101	$40.59	$32.31	3
Utah	88	$39.26	$31.99	5
Mississippi	73	$38.33	$32.38	3
West Virginia	62	$39.99	$31.20	4
Vermont	60	$40.17	$31.26	3
Rhode Island	51	$42.77	$32.22	2
New Hampshire	45	$41.10	$32.27	3
Nevada	37	$95.14	$91.88	2
Hawaii	31	$41.26	$32.23	2
Puerto Rico	29	$174.98	$122.44	1
South Dakota	26	$40.50	$31.07	1
ZZ	25	$44.50	$32.25	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.