G0416 — Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
G0416 is a HCPCS Level II code for surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusA
Active code. Paid separately under the physician fee schedule.
- Work RVU
- 3.51
- PE (non-facility)
- 7.06
- PE (facility)
- 7.06
- Malpractice RVU
- 0.11
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of G0416 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for G0416
- Long descriptor
- Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
- Short descriptor
- Prostate biopsy, any mthd
- Added
- January 1, 2009
- BETOS
- T1G
- Pricing indicator
- 13 — Physician fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price established by carriers — not otherwise classified, individual determination, or carrier discretion.
Codes adjacent to G0416
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0416 is not quite right, the correct code is very often within a few positions of it.
- G0408Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
- G0409Social 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)
- G0410Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0411Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0412Open 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
- G0413Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)
- G0414Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)
- G0415Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)
- G0417Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimensterminated
- G0418Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimensterminated
- G0419Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimensterminated
- G0420Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
- G0421Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
- G0422Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
- G0423Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session
- G0424Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per dayterminated
Questions about G0416
What is HCPCS code G0416?
G0416 is a HCPCS Level II code for surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0416?
The CMS HCPCS file marks G0416 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G0416 paid under the physician fee schedule?
G0416 carries PFS status code A. Active code. Paid separately under the physician fee schedule.