HCPCS G0416 Fee Schedule

Medicare rates as of October 2026

HCPCS G0416 is classified under Procedures / Professional Services, in the Gross and Microscopic Examinations, Prostate Biopsy subgroup.

Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method

Key Fact	Detail
Service Type	Procedures / Professional Services Gross and Microscopic Examinations, Prostate Biopsy
Hospital Outpatient Group (APC)	APC 5673 - Level 3 Pathology
Common Revenue Codes	0310 0314Sign up to view all 4
Medicare Fee Schedule	$356.72 national non-facility rate (2026)View Medicare rates for G0416
Medicaid Fee Schedule	$347.825 median of the 8 states in the free previewView Medicaid rates for G0416

National average reimbursement for HCPCS G0416 by major payers:

$424.77

BCBS / Anthem

$398.38

UnitedHealthcare

$517.14

Aetna

$401.96

Cigna

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HCPCS G0416

5 of 25 sample ratesHigher to lower in this preview

Fabiana Perna
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
INStudent in an Organized Health Care Education/Training ProgramNPI 1336776145Tax ID 59-3238640
$421.98Published rate
Andrea Torres
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLFamily Nurse PractitionerNPI 1700372471Tax ID 59-3238640
$358.69Published rate
Sarah Zhu
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLPhysician AssistantNPI 1194225508Tax ID 59-3238640
$194.94Published rate
Nikhil Bhatia
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLInternal Medicine PhysicianNPI 1275039042Tax ID 59-3238640
$192.64Published rate
Dalila Belinc
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLNurse PractitionerNPI 1083911903Tax ID 59-3238640
$163.75Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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HCPCS G0416 vs. Other Gross and Microscopic Examinations, Prostate Biopsy Codes

The table lists codes related to G0416. Select one to see its fee schedule.

Code	Description
G0415-HCPCS	Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)
G0416-HCPCS	Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
G0420-HCPCS	Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the G0416 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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Frequently Asked Questions

What APC is HCPCS G0416 assigned to?

Medicare's hospital outpatient payment system (OPPS) assigns HCPCS G0416 to APC 5673 (Level 3 Pathology). An APC groups outpatient services that Medicare pays at the same base rate.

Which revenue codes are billed with HCPCS G0416?

Hospital price transparency files list HCPCS G0416 under these revenue codes: 0310, 0314, 0312 and 0971. A revenue code names the hospital department or charge category for the line; it does not change what the service is.