CommercialBilling CodesHigh impact
00.01.73, Reimbursement of Surgical Pathology Services for Prostate Biopsy
Independence Blue Cross·Urology, Pathology, Oncology·Claims & Billing
Effective date
Mar 2, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has established a new policy requiring all prostate biopsy surgical pathology services to be billed with HCPCS code G0416 (one unit of service) regardless of the number of biopsies obtained on the same date of service. CPT code 88305 is no longer reimbursable for prostate biopsies under this plan, effective March 2, 2026.
Action Required
By March 2, 2026: Billing team must update billing software and encounter forms to enforce the following changes: (1) Replace all CPT 88305 billing codes with HCPCS G0416 for prostate biopsy surgical pathology services; (2) Configure system to report only ONE unit of service for G0416 when multiple prostate biopsies are obtained from the same individual on the same date of service by any provider; (3) Ensure CMS-1500/837p and UB-04/837i claim submissions reflect G0416 only; (4) Implement claim edits to deny or reject any prostate biopsy claims submitted with CPT 88305. Providers must document medical necessity in patient records. Claims submitted with CPT 88305 will be denied. Failure to comply will result in claim rejections and payment delays.