Payments for Pathology


Reimbursements made by insurers ultimately affect your pay, your equipment and your resources. The CAP has been intrinsically involved to ensure adequate representation for coverage and reimbursement issues facing pathologists in the legislative and regulatory landscape. We represent pathologists’ interests in nearly every payment-related policy discussion, including:

  • The only pathologist organization on the American Medical Association (AMA) Relative Value Scale Update Committee (RUC), a committee that recommends what Medicare and most private insurers pay for physician services.
  • Representatives on councils across the country that advise on local coverage determinations (LCDs) by insurers, so pathologists are appropriately reimbursed for medically reasonable and necessary services.
  • Staff advocating on your behalf on the Medicare fee schedule via submission of formal comments and face-to-face meetings.

Producing Results that Matter

CAP Advocacy Success:
Past Effects on Medicare Payments

The CAP Advocacy Successes graph demonstrates the effects of advocacy efforts over five years. The blue columns show the prior year's combined pathology and laboratory payments for pathology services. The red columns show what the payments would have been had the proposed Medicare policies taken effect.

The overall changes to professional Medicare reimbursement for pathologists in 2017 that are direct results of CAP advocacy represent a $4.55 million increase in payment to pathologists.