Pathology Consultation Request

Share
Referring Physicians

Please Visit Pathology Portal when submitting only digital images for a second opinion review.

Visit Pathology Portal

Even if you are not able to travel to New York City for an appointment, you can still receive the medical opinion of one of MSK’s world-class pathologists.

To help us assess your case, please use the form below or call 212-639-6780 Monday through Friday to (Eastern time).

I am a:

We respectfully request, in addition to the H&E slides, a block (preferable) or unstained slides to expedite cases in the event that ancillary studies are required to render a diagnosis. By definition, these are challenging cases that often necessitate such studies.

Enter Patient's Personal Information

Enter Physician's Information

Enter Patient's Medical Information

Materials for Review

The items below are not required. If you do have this information, please enter it below.

Path Number # of slides Check if MSK can retain slide
Path Number # of blocks Check if MSK can retain slide
Path Number Check if MSK can retain slide

Billing Information

What entity should be billed for charges incurred?
Please select if the hospital is the guarantor.
Please select if the patient is paying out of pocket.
Please select and enter the patient’s insurance information.
The minimum charge for a pathology consultation is $475. Any additional testing that is necessary to render a diagnosis (including immunohistochemistry stains) will be charged in addition to this fee. MSK will bill either your insurance or the patient / consult requestor directly. Please verify that MSK accepts your insurance by calling 646-227-3228.
If patient’s insurance carrier is being billed, please provide:
If the patient's insurance carrier denies payment, who will be responsible for unpaid services?
Has the patient been made aware of this referral to MSK?
Has the patient been made aware of the possibility of costs affiliated with these services?
For Medical Insurance Billing Only, is patient currently undergoing an inpatient hospital stay?
Guarantor for Payment (Please select one):
Name, contact name of invoice and address.