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Wiki G0416 VS 88035 prostate

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Wendy Anderson

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I am looking for information on prostate biopsies. From Encoder G0416 represents saturation? If that is the case 88305 appears to be the option. Is anyone seeing a denial trend? Specifically with the Blues on G0416?
 
Hi Wendy,

This is a little late for your question, but still, someone may benefit.

Generally, the HCPCS code G0416 is only billed for prostate biopsies to Medicare. It's possible that you may have a specific payor that wants the G code instead of the CPT. But in most cases, you would bill a commercial payor (the Blues, Aetna, Cigna, etc.) with the CPT 88305 x the number of specimen biopsies you have.

When billing Medicare (or as directed by another payor) with the G0416 code, you only bill for one unit. It's all-inclusive, regardless of whether the pathologist did 6 separate biopsy specimens or 20.
 
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