The lab consultancy, Lighthouse Lab Services, provides some interesting public information summaries.
Here's a new one - some payors are treating immunohistochemistry "like Genetics." Of course, IHC is not genetics - but they mean it's subject to falling prices, increasing rules and limits, even prior authorization.
See their Linked In post and a 5 page PDF.
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A recent Lighthouse Consulting brief highlights a growing reimbursement squeeze on immunohistochemistry (IHC), as payers expand coverage limitations, apply frequency edits, and demand more granular documentation of medical necessity and stain counts.
Most strikingly, in at least one UnitedHealthcare/Optum (Utah) policy, common IHC codes (88342, 88341) have been classified as “genetic testing” outside dermatologic contexts—triggering prior authorization requirements and creating post-service denial risk in workflows that historically never faced such controls.
The Lighthouse report underscores that these interpretations may not surface through routine denials but through proactive audits, and warns that pathology groups should expect tighter utilization management, more documentation scrutiny, and greater financial exposure tied to payer-specific rules. The takeaway is clear: close alignment between clinical decision-making, reporting, and revenue cycle oversight—plus ongoing policy monitoring—is now essential to protect IHC revenue.
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From the AMA CPT and online (subsc.) AMA RUC database.
88342 is first IHC, $78 tech, $33 interpretation. Physician time, 25 minutes.
2024 global 703,000. 2024 professional 1.5M. 2024 tech only 320,000.
Gastric/GI usage is 15%, breast is 5%, melanocytic nevi is 4%.
88341 is add'l IHC, $67 tech, $27 interpretation [not all that different than 88342]. Physician time [RUC, CMS may differ since payment drops $6] 25 minutes.
2024 global, 676,000. 2024 professional 2.9M. 2024 Tech only 167,000.
A substantial proportion of cases are hospital origin, because the "professional only" cases are so high. Generally the TC of IHC in the hospital setting is bundled to the surgical procedure by public claims processing codes ("SI, status indicators.")
