Newly Proposed Pathology Clinical Consult CPT Codes

In a recent Valuation of pathology consultant service codes, the College of American Pathologists (CAP) identified that 80500 and 80502 were potentially misvalued. In light of this discrepancy, the CAP contacted the AMA CPT Editorial Panel, who then worked with CMS, to further define clinical pathology consultations with more specificity.

As such, the 2022 Proposed Medicare Physician Fee Schedule (MPFS) rule outlines that current CPT codes 80500 and 80502 may be replaced with four proposed consultation codes that are more in line with the revisions made to the evaluation and management codes adopted earlier this year:

• 80XX0: Pathology clinical consultation; for a clinical problem with limited review of patient’s history and medical records and straightforward medical decision making. 5-20 minutes of total time is spent on the day of the consultation.
• 80XX1: for a moderately complex clinical problem with review of patient’s history and medical records and moderate level of medical decision making. 21-40 minutes of total time is spent on the day of the consultation.
• 80XX2: for a highly complex clinical problem with comprehensive review of patient’s history and medical records and high level of medical decision making. 41-60 minutes of total time is spent on the day of the consultation.
• 80XX3: prolonged service, each additional 30 minutes (list separately in addition to code for primary procedure).

Disclaimers:

• 80XX3 is used in conjunction with 80XX2)
• 80XX0, 80XX1, 80XX2, 80XX3 cannot be reported in conjunction with 88321, 88323, 88325
• Prolonged pathology clinical consultation service of less than 15 additional minutes is not reported separately
• Consultations involving examination of the patient should be referenced in code range 99241-99255