Summary & Overview
HCPCS G0419: Surgical Pathology for Prostate Needle Biopsy, >60 Specimens
HCPCS Level II code G0419 denotes comprehensive surgical pathology—gross and microscopic examination—for prostate needle biopsy specimens when the total exceeds 60. This code captures high-volume specimen processing and reporting for prostate cancer diagnosis and staging, and is relevant for national lab billing, pathology workload measurement, and payer coverage determinations. It matters nationally because prostate needle biopsies with high specimen counts represent complex, resource-intensive pathology services with implications for coding accuracy, reimbursement, and quality reporting.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find: benchmarks for utilization and billing patterns (where available), contextual clinical description of the service, commonly applied modifiers and documentation considerations, and policy-relevant notes on coding specificity for high specimen counts. The summary clarifies typical sites of service and clinical scenarios that generate high specimen volumes.
This publication provides a concise reference for coding staff, pathology departments, and billing administrators to ensure accurate claim submission and interpretation of G0419 in national payer contexts. Data not available in the input are explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code G0419 describes surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, more than 60 specimens. This service involves comprehensive pathological evaluation of prostate biopsy material when the specimen count exceeds 60, including examination of gross tissue and microscopic analysis to identify malignancy, histologic subtype, and other diagnostic features.
Service type: surgical pathology (anatomic pathology) specimen evaluation
Typical site of service: hospital pathology laboratory, independent pathology laboratory, or outpatient surgical center pathology service
Clinical & Coding Specifications
Clinical Context
A 66-year-old male with an elevated prostate-specific antigen (PSA) and abnormal digital rectal exam undergoes a transrectal ultrasound-guided prostate needle biopsy. Due to multifocal suspicious areas on ultrasound and prior saturation biopsy planning, the urologist obtains greater than 60 separate core specimens during a single session to maximize sampling of the peripheral and transition zones. The specimens are transported to the hospital pathology department where the surgical pathologist performs the gross accessioning, assigns individual container identifiers, and prepares representative sections. The pathology laboratory completes histologic processing, microscopic examination, immunohistochemical stains when indicated, and issues a final surgical pathology report documenting presence or absence of adenocarcinoma, Gleason/Grade Group, tumor volume estimates, perineural invasion, and margin status as applicable. Typical sites of service include an ambulatory surgery center or hospital outpatient department. Common payors encountered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing the physician's interpretive/reporting portion distinct from technical services |
TC | Technical component | Use when billing the facility/technical portion (microscopy, processing, equipment, supplies)