Does 88360 require prior authorization?

No, 88360 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 88360?

Medicare facility rate: $120.24. Non-facility rate: $120.24. Work RVU: 0.83.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.83

Facility

$120.24

Non-Facility

$120.24

Claims for ER, PR, or HER2 IHC must include the CPT code, the specimen identifier, and the unit of service (UOS) for each separately identifiable specimen.
For morphometric analysis, the claim must specify the appropriate CPT (88360 for manual or 88361 for computer-assisted) and the corresponding UOS.
Claims for IHC ER/PR/HER2 must include the appropriate CPT code(s) and unit(s) of service as specified in the policy.
Each billing party (professional and/or technical) is responsible for documenting and justifying the medical necessity of services billed.

IHC testing for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu is covered for patients with primary invasive breast cancer.
IHC testing for ER, PR, and HER2/neu is covered for patients with recurrent or metastatic breast cancer.
Immunohistochemical (IHC) testing for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu is covered for patients with primary invasive breast cancer.
IHC testing for ER, PR, and HER2/neu is covered for patients with recurrent or metastatic breast cancer.
IHC testing for estrogen receptor (ER) is covered for patients with primary invasive breast cancer and for recurrent or metastatic breast cancer.
IHC testing for progesterone receptor (PR) is covered for patients with primary invasive breast cancer and for recurrent or metastatic breast cancer.

L36805 — Lab: Special Histochemical Stains and Immunohistochemical Stains

J05

A57733 — Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains

J05

A55136 — Billing and Coding: Lab: Immunohistochemistry (IHC) Indications for Breast Pathology

J05

CGS-L35986 — Special Histochemical Stains and Immunohistochemical Stains

J18 MAC Part B

Ask Verity about documentation requirements, denial risks, or coverage in your state.