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Medicare Physician Fee Schedule

The CAP advocates fair pay for the value pathologists provide—actively representing pathologists' interests in nearly every payment-related policy discussion. The Council on Government and Professional Affairs engages with the Centers for Medicare and Medicaid Services (CMS), Congress, other physician specialty societies, and industry to ensure a favorable payment environment for pathologists and their affiliated physician practices, hospitals, and clinical laboratories.

The Medicare Physician Fee Schedule (PFS) is published annually in the Federal Register by the CMS. It contains Medicare's payment rates for each of the Current Procedural Terminology (CPT) codes used in pathology practice. The CMS publishes a Proposed Rule on or about July 1 each year, which is open to public comment for 60 days. The CMS publishes a final rule on or about November 1, which becomes effective on January 1 of the next year.

Changes in Payment Rates: Impact Tables

Advocating for You

The CAP participates in the AMA-CPT Advisory Committee as well as administers the Pathology Coding Caucus (PCC). The PCC reviews and provides recommendations to the AMA CPT Editorial Panel on applications for new or revised pathology and laboratory services. For detailed information on the AMA-CPT Process (and applying for a CPT Code) please see the AMA-CPT website.

Pathology Consultation Codes Implementation

The CAP worked with the 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 advocated for including improved codes and values for pathology clinical consultation services in the Medicare fee schedule.

Learn more about implementing these codes.

Digital Pathology Codes Implementation

The CAP worked with the AMA CPT Editorial Panel to establish digital pathology codes. The new codes are intended to capture and report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. Learn more about the 2023 Digital Pathology Codes

Participation in AMA/Specialty Society RUC

The CAP advocates for the valuation for pathology services within the Medicare Resource-Based Relative Value Scale. The CAP leads the pathology community's participation in the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The RUC makes annual recommendations regarding new and revised physician services to the CMS.

For the proposed 2024 Medicare Physician Fee Schedule, the CAP developed physician work and practice expense recommendations for pathology CPT codes identified for re-valuation. These recommendations were forwarded to the CMS for consideration and final payment decisions.

For details please see the proposed 2024 regulation webinar.

We have developed and produced a variety of materials to help further understanding of the Medicare Physician Fee Schedule.

Comment Letters

Advocacy Update Articles

Webinar Handouts