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 implemented a new policy requiring that all surgical pathology services for prostate biopsies must be billed using HCPCS code G0416 with one unit of service, regardless of the number of biopsies obtained on the same date. CPT code 88305 is no longer reimbursable for prostate biopsy pathology. This change requires immediate billing system updates to prevent claim denials.
Action Required
By March 2, 2026: Billing team must implement the following changes: (1) Update billing software edits to require HCPCS code G0416 (not CPT 88305) for all prostate biopsy surgical pathology claims submitted to Independence Blue Cross Commercial; (2) Configure system to automatically collapse multiple prostate biopsies from the same patient on the same date into a single line item with one unit of service on G0416; (3) Add claim scrubbing rules to reject or auto-correct any prostate biopsy pathology claims submitted with CPT 88305 before transmission; (4) Update encounter forms and provider education materials to instruct ordering providers and performing pathologists to use G0416 only; (5) Train all billing and claims staff on the new requirement. Failure to implement these changes will result in claim denials for prostate biopsy pathology services billed to Independence Blue Cross Commercial members.