HCPCS code G0416: Prostate pathology, 10–20 specimens2026 Medicare rate & RVUs in Maryland
Reports gross and microscopic pathology examination of 10–20 specimens from a prostate needle biopsy, after tissue sampling for suspected prostate disease.
Medicare pays $360.42–$405.44 for G0416 in the office in Maryland, from Rest of Maryland to Washington, DC area. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What G0416 covers
G0416 covers the laboratory examination of prostate needle-biopsy tissue, including gross assessment and microscopic review. A pathologist typically interprets the tissue after a urologist or other qualified clinician obtains the biopsy, whether sampling is transrectal or transperineal. The code represents the pathology service, not the act of collecting the biopsy cores. It is used for a case with 10–20 separately identified specimens submitted for examination.
Select the code by the number of specimens in the case, rather than the number of slides or tissue fragments. The pathology report and accession records should support the specimen count and findings. CMS recognizes separately priced professional and technical components: modifier 26 identifies the interpretation, while modifier TC identifies the technical work, such as laboratory processing and staff; billing without either modifier represents the global service. G0416 is not reported once for each specimen.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where G0416 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$360.42 to $405.44
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $376.68 | Unavailable |
| Rest of Maryland | $360.42 | Unavailable |
| Washington, DC area | $405.44 | Unavailable |
How the G0416 rate is calculated
Each of G0416’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0416
RVUs × geographic indexes × conversion factor
Work3.51
3.51 RVUs× 1.000 GPCI
Practice expense7.06
7.06 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
10.6800
Conversion factor
$33.4009
Medicare rate
$356.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0416
The CMS indicators that decide how G0416 is paid alongside other services.
CMS payment indicators · G0416
Prostate pathology, 10–20 specimens
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
G0416 without 26 · national office
$356.72
Prostate pathology, 10–20 specimens
G0416-26 · Professional component
$167.34
Pays only the interpretation and report.
G0416 compared with similar codes
Compare codes · National
G0416 vs 88305: Medicare rates
How to choose
- 88305Tissue pathology examLevel IV specimen
- Use 88305 for a prostate needle-biopsy case with fewer specimens; G0416 is for 10–20 specimens.
G0416 billing questions
When is G0416 used instead of 88305?
G0416 applies to a prostate needle-biopsy case with 10–20 specimens. 88305 is the related pathology code for cases below that specimen-count range.
Do I report G0416 for each core?
No. Report the code for the case when it contains 10–20 separately identified specimens; do not submit it once per core, slide, or tissue fragment.
What do modifiers 26 and TC identify?
Modifier 26 reports the professional interpretation, and modifier TC reports the technical work, including laboratory equipment and staff. Without a component modifier, the claim represents the global service.
Does G0416 include performing the biopsy?
No. It covers the pathology examination of the submitted prostate tissue, not the clinician's needle sampling procedure.
What documentation supports G0416?
The pathology accession and report should identify the prostate needle-biopsy specimens and support a case count of 10–20 specimens.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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