Pathology revenue cycle management
Pathology revenue leaks in component splits and volume - the technical and professional components, specimen-level coding and payer edits. AI agents bill every component correctly at scale.
Pathology bills high-volume, component-split claims: the technical component (TC) and professional component (26) must be billed correctly, specimens coded to the right CPT level, and claims scrubbed against payer edits. MedXFlow supports coding, verifies coverage, and runs claims, posting and denials at pathology volume.
Coding & documentation
- Specimen CPT coding - Codes specimens to the correct CPT level so nothing is under-coded.
- TC / professional split - Applies TC and 26 modifiers so technical and professional components bill correctly.
Eligibility & coverage
- Coverage & medical necessity - Verifies coverage and medical-necessity requirements for testing before billing.
Claims & submission
- High-volume claim scrubbing - Scrubs claims against payer and bundling edits at pathology volume.
- Claim status follow-up - Polls status and chases stuck claims automatically.
Posting & denials
- Payment posting - Auto-posts ERAs with line-level reconciliation.
- Denial management - Works component-split and medical-necessity denials by root cause.
What you get
- Technical and professional components billed correctly
- Specimens coded to the right level
- Clean claims at high volume
- Fewer component and medical-necessity denials
Frequently asked questions
What is the technical vs professional component in pathology?
The technical component (TC) covers the equipment, supplies and technician work; the professional component (modifier 26) covers the pathologist's interpretation. Billing them correctly, whether globally or split, is essential to getting paid for both.
Why are pathology claims denied?
Common reasons are incorrect technical/professional component billing, specimen under-coding, and medical-necessity mismatches. Correct component coding and up-front coverage checks prevent them.