Pathology surgical level IV (88305) + level V (88307)
Pathology codes are hierarchical by complexity — each specimen reported at its appropriate level.
Why this pair bundles
Per CPT, each specimen submitted under one ID gets one code. Multiple specimens reported separately.
Modifier-bypass policy
Modifier indicator: 1 — modifier 59 / XE / XP / XS / XU permitted when supporting documentation is on file.
Modifier 59 not generally needed if specimens are anatomically distinct and submitted as separate specimens.
Documentation requirements
- Pathology requisition identifies each specimen separately
- Each specimen with distinct anatomical site
Common clinical scenarios
- Skin biopsies from multiple sites - each gets appropriate level code
Frequently asked questions
Why does CMS bundle 88305 and 88307?
Per CPT, each specimen submitted under one ID gets one code. Multiple specimens reported separately.
When can I use modifier 59 (or X{EPSU}) to bypass?
Modifier 59 not generally needed if specimens are anatomically distinct and submitted as separate specimens.
What documentation supports separate billing?
Pathology requisition identifies each specimen separately; Each specimen with distinct anatomical site.
When does this conflict typically arise?
Skin biopsies from multiple sites - each gets appropriate level code.
Sources
Catch NCCI 88305/88307 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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