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prostate code G0416

Jerilen Posted Thu 23rd of April, 2015 12:58:38 PM

Is G0416 considered to be one specimen with multiple blocks? We are performing stains on multiple specimens but when we try to bill Medicare with multiple units they are denying that we can only bill one. Since we can no longer code per block, are they considering G0416 to be one specimen that you can't bill stains for multiple blocks?

SuperCoder Answered Fri 24th of April, 2015 05:29:12 AM

According to CMS; based on review of medical literature and examination of Medicare claims data- it is believed that the typical number of specimens evaluated for prostate biopsies is between 10 and 12. Looking at the global national payment amount in the final rule, you can expect to get paid for a 12-specimen prostate biopsy case using G0416, versus for the same case if you could report it with 12 units of 88305.

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