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CMS-1403-FC
As discussed in the proposed rule, we currently pay $102.35
for CPT code 88305, which is the code used by pathologists
when interpreting prostate biopsy samples. Patients
requiring a prostate saturation biopsy generally have 30 to
60 specimens taken. The pathologist would bill CPT code
88305 for evaluation of each individual specimen. When CPT
code 88305 is used to evaluate prostate saturation
biopsies, the average total payment for the evaluation of
samples from one prostate needle saturation biopsy ranges
from $3000 to $6000, depending on the number of biopsies
taken. We believe the use of CPT code 88305 to bill
individually for the evaluation of each biopsy sample would
result in overpayment for this service. Therefore, we are
proceeding with the proposal to create four G codes for
pathologic examination of prostate needle saturation tissue
sampling for services furnished beginning in 2009.
However, we agree with commenters that, rather than
having Medicare contractors price the new G codes, it would
be preferable for us to specify the payment for these
services. We generally use contractor pricing when we do
not have sufficient information to set the price. Upon
further reflection, we believe we can set prices for the
new G-codes by analogy to the current RVUs for two existing
codes: 88304 and 88305. We selected the mid-point of the
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