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HCPCS code G0416: Prostate pathology, 10–20 specimens2026 Medicare rate & RVUs in North Carolina

Reports gross and microscopic pathology examination of 10–20 specimens from a prostate needle biopsy, after tissue sampling for suspected prostate disease.

CMS RVU26DEffective Oct 1, 2026One payment locality165.5K Medicare services in 2024

In North Carolina, Medicare pays $339.60 for G0416 in the office.

$339.60Office (non-facility)
Not available in this settingHospital or facility
−4.8%vs the national office rate ($356.72)

Check a contract rate as a % of Medicare · G0416 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open G0416 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What G0416 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How North Carolina compares for G0416

Across 109 of 109 payment localities, the office rate for G0416 runs from $321.69 in Arkansas to $472.14 in San Benito County, CA. North Carolina pays $339.60. The RVUs are the same everywhere; the geographic indexes change the dollars.

G0416 in North Carolina vs other payment areas
  1. North Carolina · this page$339.60
  2. Los Angeles, CA · California$403.45+$63.85
  3. Washington, DC area · District of Columbia$405.44+$65.84
  4. Miami, FL · Florida$372.01+$32.41
  5. Chicago, IL · Illinois$363.48+$23.88
  6. Manhattan, NY · New York$404.58+$64.98
  7. Alaska · Alaska$429.02+$89.42

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

G0416 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$325.65—
ArkansasArkansas$321.69—
ArizonaArizona$348.88—
Bakersfield, CACalifornia$380.15—
Chico, CACalifornia$379.65—
El Centro, CACalifornia$379.67—
Fresno, CACalifornia$379.65—
Hanford, CACalifornia$379.65—

G0416 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$321.69

$429.02

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
G0416 office rate range by state
State / territoryOffice rate rangeLocalities
AK$429.021
AL$325.651
AR$321.691
AZ$348.881
CA$379.65–$472.1429
CO$372.421
CT$378.001
DC$405.441
DE$354.111
FL$348.19–$372.013
GA$331.96–$361.582
GU$387.481
HI$387.481
IA$334.461
ID$335.921
IL$338.27–$366.754
IN$337.621
KS$332.261
KY$330.231
LA$329.45–$343.312
MA$370.35–$406.872
MD$360.42–$405.443
ME$336.47–$353.242
MI$336.68–$350.992
MN$360.971
MO$324.08–$345.413
MS$322.991
MT$356.711
NC$339.601
ND$354.541
NE$336.281
NH$365.931
NJ$383.46–$402.092
NM$337.891
NV$356.341
NY$343.84–$411.945
OH$336.241
OK$330.671
OR$354.69–$383.832
PA$337.18–$369.212
PR$359.261
RI$366.331
SC$338.251
SD$354.281
TN$333.561
TX$335.24–$370.218
UT$342.201
VA$351.63–$405.442
VI$359.261
VT$352.551
WA$369.87–$415.442
WI$344.281
WV$327.411
WY$355.771

See G0416 in every payment locality

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

Office or facility?

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.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

15,245

Code
G0416
Physician work
3.51
Practice expense
7.06
Malpractice
0.11

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for G0416 in North Carolina
ComponentRVULocality factorAdjusted
Physician work3.51× 1.0003.5100
Practice expense7.06× 0.9336.5870
Malpractice0.11× 0.6390.0703
Total RVUs10.1673
Conversion factor× 33.4009

Office rate, North Carolina$339.60

Office: (3.51 × 1 + 7.06 × 0.933 + 0.11 × 0.639) × $33.4009 = $339.60

Open G0416 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical1Diagnostic 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.

When to use modifier 26

Codes related to G0416

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to G0416
CodeHow it relatesOffice range, North Carolina
Used instead
88305Tissue pathology exam, level IV specimenRelated prostate needle-biopsy pathology code for cases with fewer specimens than G0416's range.$66.88

How G0416 has changed in North Carolina

G0416 · Office / nonfacility

$339.60

Effective 2026-10-01

The base rate is $3.46 higher than on 2025-10-01, moving from $336.14 to $339.60 (1.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $336.14changed to$339.60

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.60 changed to 3.51
    • Practice expense RVU 7.27 changed to 7.06
    • Malpractice RVU 0.09 changed to 0.11
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $343.59changed to$336.14

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.18 changed to 7.27
    • Malpractice RVU 0.11 changed to 0.09

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $337.98changed to$343.59

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $345.03changed to$337.98

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.02 changed to 7.18
    • Malpractice RVU 0.10 changed to 0.11
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $341.26changed to$345.03

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.65 changed to 7.02
    • Malpractice RVU 0.11 changed to 0.10
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $337.37changed to$341.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.46 changed to 6.65
    • Malpractice RVU 0.09 changed to 0.11

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $332.08changed to$337.37

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.95 changed to 6.46
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $367.70changed to$332.08

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.01 changed to 5.95
    • Malpractice RVU 0.11 changed to 0.09
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $412.54changed to$367.70

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.36 changed to 7.01

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $465.21changed to$412.54

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.97 changed to 8.36
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $504.03changed to$465.21

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.09 changed to 3.60
    • Practice expense RVU 11.74 changed to 9.97
    • Malpractice RVU 0.09 changed to 0.11
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $611.29changed to$504.03

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 14.92 changed to 11.74
    • Malpractice RVU 0.06 changed to 0.09

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $608.25changed to$611.29

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $612.03changed to$608.25

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 14.97 changed to 14.92
    • Malpractice RVU 0.12 changed to 0.06
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $628.68changed to$612.03

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 16.51 changed to 14.97
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $628.68

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$339.60Not available in this settingRVU26D
2026-07-01$339.60Not available in this settingRVU26C
2026-04-01$339.60Not available in this settingRVU26B
2026-01-01$339.60Not available in this settingRVU26A
2025-10-01$336.14Not available in this settingRVU25D
2025-07-01$336.14Not available in this settingRVU25C
2025-04-01$336.14Not available in this settingRVU25B
2025-01-01$336.14Not available in this settingRVU25A
2024-10-01$343.59Not available in this settingRVU24D
2024-07-01$343.59Not available in this settingRVU24C
2024-04-01$343.59Not available in this settingRVU24B
2024-03-09$343.59Not available in this settingRVU24AR
2024-01-01$337.98Not available in this settingRVU24A
2023-10-01$345.03Not available in this settingRVU23D
2023-07-01$345.03Not available in this settingRVU23C
2023-04-01$345.03Not available in this settingRVU23B
2023-01-01$345.03Not available in this settingRVU23A
2022-10-01$341.26Not available in this settingRVU22D
2022-07-01$341.26Not available in this settingRVU22C
2022-04-01$341.26Not available in this settingRVU22B
2022-01-01$341.26Not available in this settingRVU22A
2021-10-01$337.37Not available in this settingRVU21D
2021-07-01$337.37Not available in this settingRVU21C
2021-04-01$337.37Not available in this settingRVU21B
2021-01-01$337.37Not available in this settingRVU21A
2020-10-01$332.08Not available in this settingRVU20D
2020-07-01$332.08Not available in this settingRVU20C
2020-04-01$332.08Not available in this settingRVU20B
2020-01-01$332.08Not available in this settingRVU20A
2019-10-01$367.70Not available in this settingRVU19D
2019-07-01$367.70Not available in this settingRVU19C
2019-04-01$367.70Not available in this settingRVU19B
2019-01-01$367.70Not available in this settingRVU19A
2018-10-01$412.54Not available in this settingRVU18D
2018-07-01$412.54Not available in this settingRVU18C
2018-04-01$412.54Not available in this settingRVU18B
2018-01-01$412.54Not available in this settingRVU18AR1
2017-10-01$465.21Not available in this settingRVU17D
2017-07-01$465.21Not available in this settingRVU17C
2017-04-01$465.21Not available in this settingRVU17B
2017-01-01$465.21Not available in this settingRVU17A
2016-10-01$504.03Not available in this settingRVU16D
2016-07-01$504.03Not available in this settingRVU16C
2016-04-01$504.03Not available in this settingRVU16B
2016-01-01$504.03Not available in this settingRVU16A
2015-10-01$611.29Not available in this settingRVU15D
2015-07-01$611.29Not available in this settingRVU15C
2015-04-01$608.25Not available in this settingRVU15B
2015-01-01$608.25Not available in this settingRVU15A
2014-10-01$612.03Not available in this settingRVU14D
2014-07-01$612.03Not available in this settingRVU14C
2014-04-01$612.03Not available in this settingRVU14B
2014-01-01$612.03Not available in this settingRVU14A
2013-10-01$628.68Not available in this settingRVU13D
2013-07-01$628.68Not available in this settingRVU13C
2013-04-01$628.68Not available in this settingRVU13B
2013-01-01$628.68Not available in this settingRVU13AR

Price G0416 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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

Show the CMS file lines behind this rate
RVUs for G0416PPRRVU2026_Oct_nonQPP.csv, line 15,245 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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