Laboratory Billing Services
Lab billing operates under its own rules. CLIA requirements, ABN forms, panel code bundling, reference lab billing, and molecular diagnostics.
Why Laboratory Billing Requires Specialty Expertise
Lab claims face higher denial rates due to layered compliance. Medical necessity rules are strict, CLIA certification must align with tests billed, and ABN documentation is required for uncertain coverage.
Common Laboratory CPT Codes
Our coders handle these laboratory codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Laboratory CPT Codes by State
Medicare reimbursement for laboratoryprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same laboratory CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 12 core laboratorycodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Laboratory Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 88305 | Surgical pathology, gross and microscopic, level IV | $78.98 | $69.53 | $70.92 | $76.75 | $69.48 | $69.31 | $66.22 | $68.23 | $66.88 | $67.66 |
| 88304 | Surgical pathology, gross and microscopic, level III | $47.15 | $40.56 | $41.83 | $45.52 | $40.51 | $40.59 | $38.18 | $39.69 | $38.60 | $39.31 |
| 88307 | Surgical pathology, gross and microscopic, level V | $319.69 | $274.54 | $280.85 | $307.06 | $273.94 | $272.65 | $258.44 | $268.14 | $262.06 | $265.20 |
| 88309 | Surgical pathology, gross and microscopic, level VI | $473.70 | $408.82 | $417.73 | $455.90 | $408.01 | $406.10 | $385.78 | $399.62 | $390.93 | $395.40 |
| 88312 | Special stains, group I (microorganisms) | $126.38 | $108.17 | $110.81 | $121.26 | $107.92 | $107.47 | $101.66 | $105.60 | $103.11 | $104.42 |
| 88313 | Special stains, group II (other than enzymes/microorganisms) | $94.08 | $79.70 | $81.70 | $89.81 | $79.46 | $79.02 | $74.53 | $77.64 | $75.73 | $76.68 |
| 88341 | Immunohistochemistry, each additional single antibody | $108.53 | $93.10 | $94.76 | $103.91 | $92.83 | $92.01 | $87.63 | $90.81 | $89.01 | $89.72 |
| 88342 | Immunohistochemistry, first single antibody stain | $126.65 | $108.96 | $111.14 | $121.58 | $108.69 | $107.98 | $102.67 | $106.39 | $104.16 | $105.19 |
| 88112 | Cytopathology, selective cellular enhancement, interpretation | $74.33 | $64.80 | $66.25 | $71.94 | $64.72 | $64.57 | $61.43 | $63.49 | $62.11 | $62.91 |
| 88160 | Cytopathology smears, any other source, screening and interpretation | $93.38 | $80.53 | $82.66 | $90.05 | $80.40 | $80.30 | $75.93 | $78.77 | $76.84 | $78.00 |
| 88173 | Cytopathology, fine needle aspirate, interpretation and report | $189.45 | $164.95 | $168.65 | $183.25 | $164.74 | $164.32 | $156.28 | $161.57 | $158.06 | $160.06 |
| 89220 | Sputum specimen collection by induction | $24.69 | $20.70 | $21.43 | $23.56 | $20.64 | $20.65 | $19.24 | $20.16 | $19.53 | $19.91 |
Full Laboratory fee detail by state
2026 Medicare allowables for laboratory CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 88305 | Surgical pathology, gross and microscopic, level IV | $78.98 | $78.98 |
| 88304 | Surgical pathology, gross and microscopic, level III | $47.15 | $47.15 |
| 88307 | Surgical pathology, gross and microscopic, level V | $319.69 | $319.69 |
| 88309 | Surgical pathology, gross and microscopic, level VI | $473.70 | $473.70 |
| 88312 | Special stains, group I (microorganisms) | $126.38 | $126.38 |
| 88313 | Special stains, group II (other than enzymes/microorganisms) | $94.08 | $94.08 |
| 88341 | Immunohistochemistry, each additional single antibody | $108.53 | $108.53 |
| 88342 | Immunohistochemistry, first single antibody stain | $126.65 | $126.65 |
| 88112 | Cytopathology, selective cellular enhancement, interpretation | $74.33 | $74.33 |
| 88160 | Cytopathology smears, any other source, screening and interpretation | $93.38 | $93.38 |
| 88173 | Cytopathology, fine needle aspirate, interpretation and report | $189.45 | $189.45 |
| 89220 | Sputum specimen collection by induction | $24.69 | $24.69 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Laboratory Billing Challenges We Solve
Common billing problems in laboratory and how our team handles them.
Panel Code Bundling
When to bill panels vs individual components for maximum reimbursement.
Molecular Diagnostic Coding
81200-81479 codes with payer-specific coverage policies.
ABN Compliance
Required for Medicare patients when coverage is uncertain.
CLIA Certification Alignment
Tests billed must match your lab's CLIA certificate level.
Common Laboratory Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Laboratory Practices Miss
Payer-Specific Laboratory Billing Tips
Laboratory Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert Laboratory Billing Support
Free billing assessment for your laboratory practice. See where revenue is leaking.
What We Handle for Laboratory Practices
Why Choose Go Medical Billing for Laboratory
Lab billing requires handling CLIA, ABN, panel bundling, and molecular coding simultaneously. Our team handles all of it.
We serve laboratory practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Laboratory Billing by State
We handle laboratory billing in all 50 states. The 2026 Medicare allowables for laboratory CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert Laboratory Billing Support
Stop losing revenue to laboratory coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.