● Pathology Revenue Cycle Specialists
Pathology Billing Services for Lab and Specimen Claims
Trusted by urgent care centers and multi-site groups.
97.6%
Clean claim rate
● The Real Cost of Generic Billing
Pathology billing breaks in ways general billers never catch
Every one of these is a claim your lab has probably already lost money on this month.
Missing -26 / -TC modifiers
Professional and technical component splits left off a claim trigger immediate CO-4 denials on otherwise clean pathology work.
Omitted CLIA certification numbers
A missing or mismatched CLIA number on the claim triggers an automatic CO-16 rejection — no review, no partial payment.
Bundling errors on multi-specimen cases
Multiple specimens at different complexity levels get bundled incorrectly against NCCI edits, drawing CO-97 denials.
Medical necessity gaps
ICD-10 diagnoses that don't align to payer LCDs result in CO-167 denials, even when the test itself was clinically appropriate.
MIPS reporting gaps
Missed quality measures and incomplete IA attestations quietly reduce Medicare reimbursement through payment adjustments.
Specimen complexity miscoded
Surgical pathology levels I–VI (88300–88309) coded too low routinely underpays labs for the actual work performed.
● How We Fix It
A billing team fluent in both anatomic and clinical pathology coding
We don't hand your claims to generalists. Every coder on your account is trained specifically on dual coding systems, CLIA compliance, and payer-specific pathology modifiers.
● Full-Service RCM
Every stage of pathology revenue cycle management
From eligibility checks to appealed denials, we run the parts of your revenue cycle that pull attention away from diagnostic work.
Insurance Verification
Real-time eligibility checks confirmed before or at specimen receipt, including molecular diagnostics prior authorization.
CPT & ICD-10 Coding
Specimen complexity, IHC per-antibody billing, and molecular diagnostics coded correctly by dual-certified pathology specialists.
Claim Submission & Scrubbing
Clean claims scrubbed against NCCI edits, CLIA numbers, and payer-specific requirements before they ever leave the building.
Payment Posting
ERA/EOB reconciliation posted daily so your AR reports always reflect what's actually been collected.
Denial Management
Every CO-4, CO-16, CO-97, and CO-167 denial is diagnosed, corrected, and appealed with the documentation payers require.
AR Management & MIPS Reporting
Aging claims worked back to payment, plus MIPS quality measures and IA attestations submitted on time, every cycle.
● Built For Pathology Specifically
We speak fluent CPT ranges for every specimen type you process
No learning curve, no generic templates — just billers who already know the codes your lab uses every single day.
● Why Practices Switch to Us
What actually changes when Claim Click Solutions takes over
● The Bottom Line
What specialized pathology billing does for your lab
● Case Study
How a multi-site anatomic pathology lab recovered $610K in stalled AR
A three-location pathology group came to us with a 24% denial rate driven by missing modifiers and CLIA number mismatches, plus six months of unworked accounts receivable.
● Common Questions
Pathology billing FAQ
What makes pathology billing different from general medical billing?
Pathology claims run on two separate coding systems — anatomic pathology (88000–88399) and clinical pathology (80047–85999) — plus professional/technical component splits, CLIA certification requirements, and specimen complexity levels that generalist billers routinely miss. Getting it right requires coders trained specifically on dual pathology coding.
Do you handle -26 and -TC modifiers correctly?
Yes. Every claim is coded with the correct professional-component and technical-component modifiers based on how the service was performed, so you're never denied for a missing or mismatched split.
Can you bill molecular diagnostics and immunohistochemistry?
Yes. We manage gene-specific molecular diagnostics coding and per-antibody immunohistochemistry billing, including prior authorization workflows where payers require them.
How do you prevent CLIA-related denials?
Your CLIA certification number is verified as part of charge entry, before a claim ever reaches a payer, which prevents the automatic CO-16 rejections that come from missing or mismatched CLIA information.
Do you manage MIPS reporting for pathology practices?
Yes. We handle quality measure selection, Improvement Activity attestations, and timely CMS submission so your Medicare reimbursement isn't reduced by a missed reporting requirement.
● Free Billing Audit
See exactly what your current billing process is missing
We'll review a sample of your recent pathology claims and show you where revenue is being left on the table — no cost, no obligation.