Pathologists will have new CPT codes for pathology clinical consultation services in 2022 after the Medicare program included codes developed by the CAP in its final 2022 Medicare Physician Fee Schedule. The Centers for Medicare & Medicaid Services (CMS) published the fee schedule on November 2. The CAP has advocated for including new and improved codes and values for pathology clinical consultation services on the Medicare fee schedule.

The CAP worked with the American Medical Association’s (AMA) CPT Editorial Panel to establish pathology clinical consultation codes and develop new payment rates through the CAP’s role in the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The CAP leads all reviews of pathology services that go before the RUC.

The four new pathology clinical consultation services describe physician pathology clinical consultation services provided at the request of another physician or qualified health care professional at the same or another facility or institution. The distinction among the new code family involves a degree of complexity and/or time of service, broken down by 20-minute increments each for codes 80503, 80504, and 80505, along with an add-on code 80506 reflecting additional 15–30-minutes above that spent on CPT 80505.

According to CPT, the pathology clinical consultation services (80503, 80504, 80505, 80506) may be reported when the following criteria have been met:

• The pathologist renders a pathology clinical consultation at the request of a physician or qualified healthcare professional at the same or another institution.
• The pathology clinical consultation request is in relation to pathology and laboratory findings or other relevant clinical or diagnostic information requiring additional medical interpretative judgment.

A pathologist may also render a pathology clinical consultation when mandated by federal or state regulation (eg. Clinical Laboratory Improvement Amendments).

Final Medicare Fee Schedule Impact on Pathology Payment

Overall, pathologists are facing a Medicare cut of about 3.71% next year. This reduction is due to the final 2022 conversion factor of $33.5983, representing a 3.71% decrease from 2021. This 3.71% decrease to the conversion factor stems from Medicare policy to offset increases to other physician services such as any increases to evaluation and management services.

The CAP has lobbied Congress throughout 2021 to appropriate an additional $3 billion to reduce reimbursement decreases to pathologists and other physicians affected by the cuts.

Review all the payment changes to pathology services in our final 2022 Medicare Physician Fee Schedule Impact Table.

CAP Advocacy Averts 1% Reduction in Reimbursements

In the proposed rule for 2022, pathologists were set to face an additional Medicare cut of 1% due to an update to practice expense clinical labor rates. However, thanks to CAP advocacy, the CMS agreed to delay that update, averting the additional 1% cut to pathology services.

What Will Be the Impact of the Final Fee Schedule on Your Practice?

CAP members can learn more about the final fee schedule changes by attending a complimentary webinar on December 3 at 1 PM ET where experts will review the finalized 2022 Medicare regulations and their impact on payment for pathology services.

Register today