Prostate Specimen Coding

September 16, 2022

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    

*HCPCS codes deleted in 2015: G0417, G0418, G0419

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.  

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 accommodates this change through a system program to convert 88305 to the appropriate “G” code if the patient is a Medicare or Medicaid beneficiary (or if the patient’s insurance follows Medicare guidelines).

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