G0416 Prostate biopsy, any mthd

What G0416 is

Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method

HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.

Medicare payment for G0416 (CY2026)

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.

Medically Unlikely Edit (MUE)

Medicare caps G0416 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with G0416? These codes are bundled into it

G0416 is a Column 1 code in 13 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

G0416 is bundled into these codes

G0416 appears as a Column 2 code in 3 active edits. Reported with one of these Column 1 codes on the same date of service, G0416 is the code that denies.

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.