CPT | HCPCS | ICD-10 | 99.8% BILLING ACCURACY

Pathology Medicine Billing Services

Pathology billing is unlike any other medical specialty. It demands a granular understanding of diagnostic coding, precise documentation, and payer-specific nuances. From surgical pathology to molecular diagnostics, billing in this field requires specialized knowledge and accurate code capture across various disciplines.

Our tailored billing solutions help pathology providers, independent labs, and hospital departments minimize denials, reduce manual errors, and accelerate the payment cycle. Whether it's CPT, HCPCS, ICD-10, or modifier use — we ensure everything is accurate, complete, and audit-ready.

99.8% billing accuracy
<4% denial rate
Claim turnaround under 48 hours
20% improvement in revenue cycle efficiency

25–30% increase in cash flow & collections
A/R days cut down to <30
Up to 11.8% increase in reimbursements year-over-year
CLIA, HIPAA, Medicare Part B compliant

99.8% Billing Accuracy

<4% Denial Rate

<30 Days A/R Days

11.8% Reimbursement Growth

Why Pathology Billing is Intricate

Dual Components

Technical component + professional component billing requirements.

Frequent Modifiers

High use of modifiers (TC, -26, -XL, -59) for accurate claims.

Complex Test Types

Multiple testing types: qualitative & quantitative.

Genetic Studies

Complex panels, reflex tests, and genetic studies.

High Claim Volume

High volume of claims with low per-claim value.

Core Pathology Billing Services We Offer

Our pathology medicine services cover everything from start to finish, fully integrated with your lab systems.

Eligibility Verification & Prior Authorization
Accurate Charge Entry for all subspecialties (Cytology, Hematology, Molecular, Anatomical, Clinical Pathology)
CPT, HCPCS & ICD-10 Coding — listing specialty-specific rules
Claim Scrubbing before submission
Electronic Claims Submission — 48-hour turnaround
Payment Posting & Denial Management
A/R Follow-up & Recovery
Audit & Compliance Monitoring (CLIA, HIPAA, Medicare Part B)

Pathology Specialties We Handle

We bill across all major branches of pathology, including:

Disease-oriented panels Molecular pathology Urinalysis & in-house lab procedures Surgical pathology Hematology Cytopathology Reproductive medicine Anatomical & clinical pathology Toxicology & drug assay panels

Who We Serve

Independent pathology labs
Hospital-based pathology departments
Genetic & molecular diagnostic centers
Toxicology labs
Dermatopathologists, neuropathologists, and surgical pathologists

Proven Outcomes 99.8% billing accuracy
 <4% denial rate
 Claim turnaround under 48 hours
 20% improvement in revenue cycle efficiency
 25–30% increase in cash flow & collections
 A/R days cut down to <30
 Up to 11.8% increase in reimbursements year-over-year
Why Choose Our Pathology Medical Services in New York? Certified Pathology Coders with CPC, CCS, and CPMA
 Deep expertise in all specialties and correct billing
 Seamless integration with LIS (Lab Information Systems)
 Dedicated team for specialty-specific audit prep
 Transparent reporting dashboards with actionable updates

Coding Examples

We follow payer-specific guidelines and assign correct CPT/HCPCS codes, including:

88302Surgical pathology, gross and microscopic examination (Level II)

88304Surgical pathology, gross and microscopic examination (Level III)

88305Surgical pathology, gross and microscopic examination (Level IV)

88309Surgical pathology, gross and microscopic examination (Level VI)

88342Cytopathology (Pap smear, manual screening)

ICD-10Common ICD-10 codes: C50 (breast cancer), D05 (carcinoma in situ), C18 (rectal cancer), C18 (colon cancer), D12 (benign neoplasms)

Our Proven Results

What pathology billing partners consistently experience:

99.8% Billing Accuracy

<4% Denial Rate

30% Cash Flow Increase

11.8% Reimbursement Boost YoY

Book a Free Pathology Medicine Billing Audit Today!

Let our pathology billing specialists identify missed revenue and compliance risks — completely free.

Get Free Audit

Frequently Asked Questions (FAQs)
                                    1. How do you manage split billing for pathology services?
                                    
Pathology billing often requires split billing — separating the technical component (TC) and professional component (26) of a service. We apply the correct modifiers (-TC, -26) based on your facility's billing agreement and payer contracts to ensure both components are billed and reimbursed accurately.

                                    2. Can you handle complex panel testing and reflex testing?
                                    
Yes. We are experienced with complex panel coding, reflexive test reporting, and disease-oriented panel billing. We ensure correct code assignment based on the ordered tests, avoiding unbundling errors and maximizing reimbursement within payer coverage guidelines.

                                    3. Do you support pathology-specific compliance audits?
                                    
Yes. We have a dedicated audit team for pathology compliance that reviews claims against CLIA regulations, Medicare Part B policies, and payer-specific coverage rules. We prepare audit-ready documentation and perform proactive internal audits to prevent compliance issues before they occur.

                                    4. What is the turnaround time for claim submission?
                                    
We submit all pathology claims within 48 hours of receiving complete encounter data. Each claim undergoes automated edit checks and manual coder review, ensuring clean submissions that minimize rejections and speed up payment posting.

                                    5. Which LIS systems do you integrate with?
                                    
We integrate with all major Laboratory Information Systems (LIS) including Epic Beaker, Cerner PathNet, Sunquest, Orchard, and custom lab platforms. Our onboarding team handles the technical integration to ensure seamless data flow from your LIS to billing without manual re-entry.

                                    6. Can you handle hospital-based and independent labs?
                                    
Absolutely. We serve both hospital-based pathology departments and independent labs. For hospital-based departments, we coordinate with facility billing teams and handle the professional component. For independent labs, we provide complete end-to-end billing including eligibility, coding, submission, and follow-up.