G0416 HCPCS code: Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
G0416 is the HCPCS Level II code for surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method. In 2024 Medicare paid an average of $189.10 per service for G0416 across 165,539 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 14% from 2022 to 2024 (144,620 to 165,539 services). In 2024, about 6,766 clinicians billed Medicare for G0416 for 149,563 beneficiaries; California, Texas, Florida accounted for 21% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 13 |
| BETOS category | T1G |
| Added | 2009-01-01 |
| Last action effective | 2015-01-01 |
Who bills G0416 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 6,766 |
| Medicare beneficiaries | 149,563 |
| States with claims | 54 |
| Share of services in top 3 states (California, Texas, Florida) | 21% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0416, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 144,620 | 129,749 | $245.65 | $192.97 |
| 2023 | 149,008 | 134,012 | $244.69 | $191.84 |
| 2024 | 165,539 | 149,563 | $240.68 | $189.10 |
States with the most G0416 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 14,755 | $206.20 |
| Texas | 11,138 | $191.46 |
| Florida | 9,615 | $196.99 |
| New York | 8,686 | $200.14 |
| Illinois | 8,556 | $211.64 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
What changed for G0416
- 2009-01-01: G0416 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0416?
G0416 is the HCPCS Level II code for surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method. Short descriptor: "Prostate biopsy, any mthd".
How much does Medicare pay for G0416?
In 2024, the average Medicare payment was $189.10 per service (average allowed $240.68).
Does Medicare cover G0416?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G0416 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G04 codes
- G0400 — Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
- G0402 — Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
- G0403 — Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
- G0404 — Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
- G0405 — Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
- G0406 — Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
- G0407 — Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
- G0408 — Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
- G0409 — Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)
- G0410 — Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0411 — Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0412 — Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed
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Next steps
- Run a reimbursement report for a device billed under G0416
- Watch G0416 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0416
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.