HCPCS Level II code G0416 denotes surgical pathology services for prostate needle biopsy specimens, encompassing both gross and microscopic examinations. This code is used when pathologists process and interpret prostate tissue obtained via needle biopsy to determine histologic diagnoses such as benign prostatic tissue, prostatic intraepithelial neoplasia, or carcinoma. Nationally, accurate coding of prostate biopsy pathology is important for clinical documentation, quality measurement, and payment integrity across laboratory and hospital settings.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the common billing modifiers associated with pathology services. The publication also covers benchmark considerations and policy-relevant topics affecting lab and hospital billing for surgical pathology, such as appropriate use of pathology-specific procedure codes and implications for claim adjudication.

This summary equips clinicians, coders, and revenue cycle professionals with a clear understanding of what G0416 represents, where it is performed, and the kinds of documentation and claim elements commonly associated with prostate needle biopsy pathology services. Data not available in the input is noted where applicable in detailed sections.