Death of Prostate Bx's

Prostate Biopsy HCPCS Codes

As of January 1, 2015, there will be only one code you can report to CMS for prostate needle specimens:

G0416 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, any number of specimens

Deleted for 2015 are:

G0417 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-41 specimens

G0418 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens

G0419 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, greater than 60 specimens

You cannot report 88305 for a prostate needle biopsy for a Medicare beneficiary. Code G0416 has a global, professional and technical component in the physician fee schedule and the appropriate modifier can be appended (TC or -26) depending on the billing circumstances. The national allowed charge for 2015 for code G0416 professional component will be $182.58 when compared to 88305 for 12 prostate biopsies will be $468.26.

As this is only a guideline for a Medicare beneficiary, continue to report 88305 for the appropriate number of separately identified specimens. APS Medical Billing is prepared to accommodate this change through a system program to convert 88305 to the appropriate “G” code if the patient is a Medicare or Medicaid beneficiary.