Medicare AdvantageBilling CodesHigh impact
MA00.058, 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 Medicare Advantage has established a new policy (MA00.058) effective 03/02/2026 that mandates 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. CPT code 88305 is no longer reimbursable for prostate biopsy pathology. Billing teams must immediately update systems to enforce G0416 usage and reject 88305 claims for this service line.
Action Required
By 02/28/2026: Billing team must update billing system edits to mandate HCPCS code G0416 for all prostate biopsy surgical pathology claims submitted to Independence Blue Cross Medicare Advantage. Configure system to automatically reject or flag claims using CPT code 88305 for prostate biopsies. Notify all in-house providers and external billing partners of the coding requirement change. Update charge capture templates and encounter forms to default to G0416. Providers must document that all prostate biopsies from the same patient on the same date of service are billed as a single line item with G0416 and one unit of service. Failure to use G0416 will result in claim denials for this service.