G0416 Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method...
HCPCS Procedure & Supply Codes
Need more information about G0416? Get access to fees, crosswalks, billing policies, similar codes and much more. Access to this feature is available in the following products:
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Additional Code Information includes:
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Save time with a Professional or Facility subscription! You will be able to see the most common modifiers billed to Medicare along with this code.
HCPCS Index Entries (Reverse Index Lookup) 
reverse_index/reverse_index_content.php?set=HCPCS&c=G0416
View historical information about the code including when it was added, changed, deleted, etc. Access to this feature is available in the following products:
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Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. Access to this feature is available in the following products:
Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. |
Medicare Processing Note #0008
THIS PROCESSING NOTE DELETED 1/1/97.
Medicare - Carrier Priced
Subscribers will see related documentation, coding and billing tips. Access to this feature is available in the following products:
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DMEPOS Products (Durable Medical Equipment, Prosthetics, Orthotics, Supplies)
dmepos/dmepos_content.php?set=HCPCS&c=G0416
Calculated for National Unadjusted (00000)
* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.
Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|---|---|---|---|
| (none) | $354.52 | $531.78 | $709.04 | (your fee) |
| 26 | $166.91 | $250.36 | $333.82 | (your fee) |
| TC | $187.61 | $281.41 | $375.22 | (your fee) |
Access to calculated fee values is available. Access to this feature is available in the following products:
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Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays |
|---|---|---|---|
| (none) | $354.52 | $##.## | $##.## |
| 26 | $166.91 | $##.## | $##.## |
| TC | $187.61 | $##.## | $##.## |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| 26 | $##.## | $##.## | $##.## | $##.## |
| TC | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| 26 | $##.## | $##.## | $##.## | $##.## |
| TC | $##.## | $##.## | $##.## | $##.## |
Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|---|---|---|---|
| (none) | $354.52 | $531.78 | $709.04 | (your fee) |
| 26 | $166.91 | $250.36 | $333.82 | (your fee) |
| TC | $187.61 | $281.41 | $375.22 | (your fee) |
Access to calculated fee values is available. Access to this feature is available in the following products:
Note: Subscribers will see the calculated values below. |
Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays |
|---|---|---|---|
| (none) | $354.52 | $##.## | $##.## |
| 26 | $166.91 | $##.## | $##.## |
| TC | $187.61 | $##.## | $##.## |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| 26 | $##.## | $##.## | $##.## | $##.## |
| TC | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| 26 | $##.## | $##.## | $##.## | $##.## |
| TC | $##.## | $##.## | $##.## | $##.## |
This section shows APC information including: Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more. Access to this feature is available in the following products:
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View fees for this code from 4 different built-in fee schedules and from those you've added using the Compare-A-Fee™ tool. If you work with several fee schedules or would like to create custom fee comparison reports, you need our exclusive Compare-A-Fee™ tool.
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View a table of UCR, Worker's Comp, and Medicare Fees here, as well as see UCR Fees in the charts below. Access to this feature is available in the following products:
Note: Subscribers will see the fee graphs below. |
View a chart showing the last 8+ years of Medicare denial rates, Medicare Allowed amounts, and Medicare billed amounts. Access to this feature is available in the following products:
Note: Subscribers will see the fee graphs below. |
Calculated for National Unadjusted (00000)
* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.
RVU Components (by modifier)
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
|---|---|---|---|---|
| (none) | 3.6 | 7.27 | 0.09 | 10.960 |
| 26 | 3.6 | 1.51 | 0.05 | 5.160 |
| TC | 5.76 | 0.04 | 5.800 |
Access to calculated fee values is available. Access to this feature is available in the following products:
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Practitioner Labor
| Pre-Service | Intra-Service | Post-Service | Total Time* |
|---|---|---|---|
| ## | ## | ## | ## min |
* Total Time may be greater than the displayed components.
Work RVU Components (by modifier)
| Modifier | National Unadjusted Work RVU | Work GPCI | Adjusted Work RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 3.6 |
| 26 | ##.## | ##.## | 3.6 |
| TC | ##.## | ##.## |
Clinical Labor - Direct Expense
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time |
|---|---|---|---|---|---|
| Lab Technician | $0.55 / min | ## min | ## min | ## min | ## min |
| Histotechnologist | $0.64 / min | ## min | ## min | ## min | ## min |
Equipment - Direct Expense
| Item | Purchase Price | Expected Life | Total Time |
|---|---|---|---|
| grossing station w-heavy duty disposal | $##.## | ## years | ## min |
| hood, fume | $##.## | ## years | ## min |
| microscope, compound | $##.## | ## years | ## min |
| paraffin dispenser (two-gallon) | $##.## | ## years | ## min |
| slide coverslipper, robotic | $##.## | ## years | ## min |
| slide dryer | $##.## | ## years | ## min |
| slide etcher-labeler | $##.## | ## years | ## min |
| slide stainer, automated, high-volume throughput | $##.## | ## years | ## min |
| solvent recycling system | $##.## | ## years | ## min |
| tissue embedding center | $##.## | ## years | ## min |
| tissue processor | $##.## | ## years | ## min |
| water bath, general purpose (lab) | $##.## | ## years | ## min |
| Freezer | $##.## | ## years | ## min |
| Automated Casette Labeler | $##.## | ## years | ## min |
| instrument pack, basic ($500-$1499) | $##.## | ## years | ## min |
| loupes, standard, up to 3.5x | $##.## | ## years | ## min |
| microtome | $##.## | ## years | ## min |
Supplies - Direct Expense
| Item | Unit Price | Quantity | Unit | Amount |
|---|---|---|---|---|
| gloves, non-sterile, nitrile | $##.## | ## | pair | $##.## |
| gown, staff, impervious | $##.## | ## | item | $##.## |
| mask, surgical | $##.## | ## | item | $##.## |
| biopsy sponge (Histo-Prep) | $##.## | ## | item | $##.## |
| blade, microtome | $##.## | ## | item | $##.## |
| eye shield, non-fog | $##.## | ## | item | $##.## |
| gauze, non-sterile 4in x 4in | $##.## | ## | item | $##.## |
| towel, paper (Bounty) (per sheet) | $##.## | ## | item | $##.## |
| bleach | $##.## | ## | ml | $##.## |
| cover slip, glass | $##.## | ## | item | $##.## |
| cup, biopsy-specimen non-sterile 4oz | $##.## | ## | item | $##.## |
| embedding cassette | $##.## | ## | item | $##.## |
| embedding mold | $##.## | ## | item | $##.## |
| embedding paraffin | $##.## | ## | kg | $##.## |
| fixative (for tissue specimen) | $##.## | ## | ml | $##.## |
| fixative processing (buffered formalin) | $##.## | ## | ml | $##.## |
| histology freezing spray (Freeze-It) | $##.## | ## | oz | $##.## |
| label for microscope slides | $##.## | ## | item | $##.## |
| mold release agent, liquid | $##.## | ## | ml | $##.## |
| mounting media (Histomount) | $##.## | ## | ml | $##.## |
| slide, microscope | $##.## | ## | item | $##.## |
| stain, hematoxylin | $##.## | ## | ml | $##.## |
| xylenes solvent | $##.## | ## | ml | $##.## |
| ethanol, 100% | $##.## | ## | ml | $##.## |
| ethanol, 70% | $##.## | ## | ml | $##.## |
| stain, eosin | $##.## | ## | ml | $##.## |
| ethanol, 95% | $##.## | ## | ml | $##.## |
| Paraffin repel | $##.## | ## | ml | $##.## |
| Clarifier | $##.## | ## | ml | $##.## |
| wipes, lens cleaning (per wipe) (Kimwipe) | $##.## | ## | item | $##.## |
Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.
PE RVU Components (by modifier)
| Modifier | National Unadjusted PE RVU | PE GPCI | Adjusted PE RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 7.270 |
| 26 | ##.## | ##.## | 1.510 |
| TC | ##.## | ##.## | 5.760 |
RVU Components (by modifier)
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
|---|---|---|---|---|
| (none) | 3.6 | 7.27 | 0.09 | 10.960 |
| 26 | 3.6 | 1.51 | 0.05 | 5.160 |
| TC | 5.76 | 0.04 | 5.800 |
Access to calculated fee values is available. Access to this feature is available in the following products:
Note: Subscribers will see the calculated values below. |
Practitioner Labor
| Pre-Service | Intra-Service | Post-Service | Total Time* |
|---|---|---|---|
| ## | ## | ## | ## min |
* Total Time may be greater than the displayed components.
Work RVU Components (by modifier)
| Modifier | National Unadjusted Work RVU | Work GPCI | Adjusted Work RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 3.6 |
| 26 | ##.## | ##.## | 3.6 |
| TC | ##.## | ##.## |
Clinical Labor (Non-Facility)- Direct Expense
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time |
|---|---|---|---|---|---|
| Lab Technician | $0.55 / min | ## min | ## min | ## min | ## min |
| Histotechnologist | $0.64 / min | ## min | ## min | ## min | ## min |
Equipment (Non-Facility)- Direct Expense
| Item | Purchase Price | Expected Life | Total Time |
|---|---|---|---|
| grossing station w-heavy duty disposal | $##.## | ## years | ## min |
| hood, fume | $##.## | ## years | ## min |
| microscope, compound | $##.## | ## years | ## min |
| paraffin dispenser (two-gallon) | $##.## | ## years | ## min |
| slide coverslipper, robotic | $##.## | ## years | ## min |
| slide dryer | $##.## | ## years | ## min |
| slide etcher-labeler | $##.## | ## years | ## min |
| slide stainer, automated, high-volume throughput | $##.## | ## years | ## min |
| solvent recycling system | $##.## | ## years | ## min |
| tissue embedding center | $##.## | ## years | ## min |
| tissue processor | $##.## | ## years | ## min |
| water bath, general purpose (lab) | $##.## | ## years | ## min |
| Freezer | $##.## | ## years | ## min |
| Automated Casette Labeler | $##.## | ## years | ## min |
| instrument pack, basic ($500-$1499) | $##.## | ## years | ## min |
| loupes, standard, up to 3.5x | $##.## | ## years | ## min |
| microtome | $##.## | ## years | ## min |
Supplies (Non-Facility)- Direct Expense
| Item | Unit Price | Quantity | Unit | Amount |
|---|---|---|---|---|
| gloves, non-sterile, nitrile | $##.## | ## | pair | $##.## |
| gown, staff, impervious | $##.## | ## | item | $##.## |
| mask, surgical | $##.## | ## | item | $##.## |
| biopsy sponge (Histo-Prep) | $##.## | ## | item | $##.## |
| blade, microtome | $##.## | ## | item | $##.## |
| eye shield, non-fog | $##.## | ## | item | $##.## |
| gauze, non-sterile 4in x 4in | $##.## | ## | item | $##.## |
| towel, paper (Bounty) (per sheet) | $##.## | ## | item | $##.## |
| bleach | $##.## | ## | ml | $##.## |
| cover slip, glass | $##.## | ## | item | $##.## |
| cup, biopsy-specimen non-sterile 4oz | $##.## | ## | item | $##.## |
| embedding cassette | $##.## | ## | item | $##.## |
| embedding mold | $##.## | ## | item | $##.## |
| embedding paraffin | $##.## | ## | kg | $##.## |
| fixative (for tissue specimen) | $##.## | ## | ml | $##.## |
| fixative processing (buffered formalin) | $##.## | ## | ml | $##.## |
| histology freezing spray (Freeze-It) | $##.## | ## | oz | $##.## |
| label for microscope slides | $##.## | ## | item | $##.## |
| mold release agent, liquid | $##.## | ## | ml | $##.## |
| mounting media (Histomount) | $##.## | ## | ml | $##.## |
| slide, microscope | $##.## | ## | item | $##.## |
| stain, hematoxylin | $##.## | ## | ml | $##.## |
| xylenes solvent | $##.## | ## | ml | $##.## |
| ethanol, 100% | $##.## | ## | ml | $##.## |
| ethanol, 70% | $##.## | ## | ml | $##.## |
| stain, eosin | $##.## | ## | ml | $##.## |
| ethanol, 95% | $##.## | ## | ml | $##.## |
| Paraffin repel | $##.## | ## | ml | $##.## |
| Clarifier | $##.## | ## | ml | $##.## |
| wipes, lens cleaning (per wipe) (Kimwipe) | $##.## | ## | item | $##.## |
Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.
PE RVU Components (by modifier)
| Modifier | National Unadjusted PE RVU | PE GPCI | Adjusted PE RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 7.270 |
| 26 | ##.## | ##.## | 1.510 |
| TC | ##.## | ##.## | 5.760 |
Cross-A-Code™ (ICD-9/10, CPT, Modifiers, NCCI, NDC, ASA CROSSWALK®)
crosswalks/crosswalk_content.php?set=HCPCS&c=G0416
View relationships (or crosswalks) between code sets. Access to this feature is available in the following products:
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Medicare Policies & Guidelines (Articles, LCDs, NCDs)
coverage/coverage_content.php?set=HCPCS&c=G0416
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