"A Rising Tide lifts all Boats" - CMS reimbursements x Digital Pathology

The value created by pathology subspecialty remote reporting and lightning-fast Turn-Around-Time for patients has long been overlooked by insurance. The recent addition of Digital Pathology CPT codes are bound to make digital pathology in routine reporting a norm.

We, Morphle Labs Inc. are one of the most popular slide scanners globally and have been serving the market with cutting-edge products that help Pathlabs fly 3X faster.

We congratulate the AMA on this big step that will elevate the status quo of the pathology industry.

For the interested audience, we have summarized the codes introduced so far with references included.
The reference to the CPT codes [ jump to report ]

Digital Pathology consists of hardware that captures auto-focussed images of pathology specimens (on glass slides) and effectively converts a physical specimen into a large highly resolved continuous digital image. This is known as a whole slide image, the 21st-century equivalent of microscopy. This enables pathology workflow remotely on a comfortable computer screen, instead of bending over not-so-ergonomic microscopes.
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The digital nature of the output unravels all the goodness of software workflows including assistive AI modules.

The value this creates is multi-fold
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However, despite the value created, most high-quality scanners are perceived as prohibitively expensive and prevent a large subset of labs from taking the leap.
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Morphle Digital Pathology has pre-emptively solved the “Return of Investment” problem by introducing a truly affordable high-throughout scanner while beating the standard technical specs w.r.t image resolution, scanning speed & more.

Category III codes represent a provisional collection of codes commonly employed for newly emerging technologies, services, procedures, and service models, for the purpose of data collection, and assessment and to establish the potential for payment of new services.  They may be employed, when suitable, as supplementary codes for specific frequently offered services.

The new codes are intended to help pathology practices, and laboratories providing digital pathology procedures to appropriately report them (to a patient health record and/or payer). Any reimbursement for a CPT Category III code is determined at the Medicare Administrative Contractor (MAC) level and/or other public or private payer level, with the provider being responsible for justifying payment on a case-by-case basis.

Now, If your medical practice has already started leveraging digitizing glass microscope slides to capture images for primary readouts, instead of physically inspecting glass slides through a microscope, it is essential for you to begin utilizing the 13 newly introduced supplementary CPT codes. These codes are designed to account for the extra effort and costs involved. Pathologists who utilize digital pathology technology now have the option to include these new add-on procedures when billing for a variety of their services. The new CPT Category III codes are add-on codes that are reported in addition to the appropriate Category I service code. For example, when billing the code 88305 for a surgical pathology service, you would report the new add-on code +0753T to represent the digitization of glass slides for the microscopic examination.

List of add-on CPT codes

The new digital pathology Category III CPT codes are used to report the additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. Although pathologists may not receive a specific payment amount right away when using the codes, they will help pathologists, pathology practices, and laboratories appropriately report digital pathology digitization procedures when providing these services to Medicare beneficiaries.

In order to be recognized by payers in the future, pathologists need to first demonstrate that the technology of digital pathology services has been adopted and used for primary diagnosis. Billing data can also support the development of studies and literature supporting the efficacy of the services.

However, this goodness is only for primary readouts and cannot be reported when digitization is used for archival, educational, or developing a database for training or validation of AI algorithms, or solely for clinical presentations (e.g., tumor board or interdisciplinary conferences).

Given that new-age scanners are not only capable of regular histopathology but with better-focusing algorithms have given pathologists the confidence to report cytology cases, and with true 100x oil objectives (ex. Hemolens), the power to report PBS, Bone Marrow Aspirates, and more.

The AMA has released details on 30 new category III digital pathology CPT® codes for reporting cytology, frozen sections & more that will go live  on January 1, 2024.

Clients who are preparing the digitized slide images should be billing the add-on charge. Typically, the Category III codes will be associated with the TC component. However, some charges (such as peripheral blood smear review, CPT 85060) do not have separate TC/PC component modifiers - in these cases whoever prepares the digitized slide images or provides the digitization procedure may report the applicable add-on Category III code.

If you are intrigued, here are a few pointers 
1. How to choose a slide scanner - [link]
2. Experience the online viewers / validate image resolution - [link]
3. Speak to an expert to decipher the right digital pathology workflow for your setup - [link]
4. Learn the pricing details for our slide scanners - [link]