$67.37
Use 88305 for a prostate needle-biopsy case with fewer specimens; G0416 is for 10–20 specimens.
On this page
CMS RVU26D · Effective 2026-10-01
G0416 Prostate pathology Medicare reimbursement rates in Utah
Reports gross and microscopic pathology examination of 10–20 specimens from a prostate needle biopsy, after tissue sampling for suspected prostate disease. Compare G0416 office and facility rates across CMS payment localities in Utah.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0416 in Utah?
Utah has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$342.20
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Surgical pathology
About G0416: Prostate biopsy pathology examination
Reports gross and microscopic pathology examination of 10–20 specimens from a prostate needle biopsy, after tissue sampling for suspected prostate disease.
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.
CMS billing rules for G0416
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU3.51 · 33%
- Practice expense (office) RVU7.06 · 66%
- Malpractice RVU0.11 · 1%
165.5K
Medicare services in 2024 · #422 by national volume
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.
G0416 compared with similar codes
Office rates for Utah, from the same CMS release.
Compare G0416 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Utah →
Office / nonfacility
$342.20
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for G0416 in Utah.
PPRRVU2026_Oct_nonQPP.csv
15,245
- Code
- G0416
- Physician work
- 3.51
- Practice expense
- 7.06
- Malpractice
- 0.11
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.51 | × 1.000 | 3.5100 |
| Practice expense | 7.06 | × 0.940 | 6.6364 |
| Malpractice | 0.11 | × 0.898 | 0.0988 |
| Total RVUs | 10.2452 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$342.20
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.51 | 1 |
| Practice expense | 7.06 | 0.94 |
| Malpractice | 0.11 | 0.898 |
(3.51 × 1 + 7.06 × 0.94 + 0.11 × 0.898) × $33.4009 = $342.20
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,242G0413,,Pelvic ring fracture uni/bil,A,,15.34,10.68,NA,10.68,,3.26,29.28,29.28,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,243G0414,,Pelvic ring fx treat int fix,A,,14.28,10.35,NA,10.35,,3.04,27.67,27.67,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,244G0415,,Open tx post pelvic fxcture,A,,20.41,12.26,NA,12.26,,4.43,37.10,37.10,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,245G0416,,"Prostate biopsy, any mthd",A,,3.51,7.06,,7.06,NA,0.11,10.68,10.68,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,246G0416,26,"Prostate biopsy, any mthd",A,,3.51,1.44,,1.44,,0.06,5.01,5.01,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,247G0416,TC,"Prostate biopsy, any mthd",A,,0.00,5.62,,5.62,NA,0.05,5.67,5.67,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,248G0420,,Ed svc ckd ind per session,A,,2.12,1.15,,1.15,NA,0.13,3.40,3.40,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985