Laboratory Prostate Biopsies (G0416) — Medicare Advantage Payment Policy
Medicare Advantage payment policy for reimbursement of surgical pathology (gross and microscopic) for prostate needle biopsy (G0416); applies to claims for Humana Medicare Advantage members and specifies eligible diagnostic indications for reimbursement.
No material clinical or coverage changes in this revision.
Reimbursable Indications
Reimbursable indications for G0416
G0416 is reimbursable only when one of the following clinical indications is present:
ANY of the following
- Elevated prostate specific antigen (PSA)
- Prostate cancer
- Benign neoplasm of prostate
- Enlarged or nodular prostate
- Prostatitis
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.