How much does Medicare pay for HCPCS G0416?

Medicare allowed an average of $245.93 per service and paid $193.24 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1082.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code G0416?

Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method. It was billed 149,897 times to 144,853 Medicare beneficiaries by 2,762 providers in 2024.

Does G0416 pay differently in an office than a hospital?

Yes. The allowed amount averaged $291.61 in an office setting and $172.35 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills G0416 most?

Pathology, with 109,689 services from 2,414 clinicians. Next are Clinical Laboratory, Urology, Dermatology.

HCPCS G0416

Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method

$245.93Medicare-allowed amount per service, averaged across 149,897 services

Providers submitted

$1082.01

Asking price, not received

Medicare allowed

$245.93

The fee schedule figure

Medicare paid

$193.24

Balance is patient coinsurance

Providers submitted an average of $1082.01 for this code and Medicare allowed $245.93 — 4.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $193.24 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $291.61
Hospital / facility: $172.35

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 92,482 services were billed in an office setting and 57,415 in a facility.

Services: 149,897
Beneficiaries: 144,853
Providers billing it: 2,762
Total allowed: $36,864,169

What Medicare pays for HCPCS G0416

Across 149,897 services billed by 2,762 providers to 144,853 beneficiaries, Medicare allowed an average of $245.93 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills G0416

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	109,689	107,436	$240.78	2,414
Clinical Laboratory	35,051	32,368	$269.92	171
Urology	4,856	4,753	$194.49	168
Dermatology	74	72	$87.57	1
Gastroenterology	54	54	$197.29	1
Pain Management	42	42	$196.76	1
Diagnostic Radiology	40	39	$162.74	2
General Practice	32	32	$173.39	1
Internal Medicine	24	22	$179.67	1
Emergency Medicine	18	18	$175.37	1
Anesthesiology	17	17	$169.48	1

G0416 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	13,551	$263.85	$185.93	255
Texas	9,804	$252.57	$200.71	158
Florida	8,609	$255.08	$200.94	171
New York	8,116	$256.86	$183.74	155
Illinois	7,920	$275.20	$211.07	114
Tennessee	7,911	$270.00	$226.48	72
Pennsylvania	6,982	$273.17	$200.04	140
New Jersey	6,314	$316.81	$223.81	88
Utah	5,799	$308.29	$265.54	17
Massachusetts	5,275	$206.96	$149.48	117
Ohio	4,663	$191.10	$154.61	138
Oklahoma	4,435	$260.56	$221.15	25
Virginia	4,139	$250.12	$196.11	64
Colorado	3,919	$241.41	$178.76	49
North Carolina	3,904	$179.64	$147.03	78
Washington	3,597	$210.47	$157.13	64
Arizona	3,345	$249.70	$202.03	51
Georgia	3,156	$210.72	$171.89	65
Maryland	3,061	$331.53	$234.49	29
Michigan	2,986	$243.22	$186.71	68
South Carolina	2,759	$208.77	$171.40	56
Missouri	2,712	$187.48	$150.94	60
Indiana	2,499	$208.96	$170.93	66
Wisconsin	2,340	$176.33	$136.47	73
Minnesota	2,218	$256.52	$198.66	59
Connecticut	2,153	$265.11	$195.10	43
Kansas	2,101	$189.43	$155.37	42
Louisiana	2,062	$165.85	$138.12	52
Iowa	1,452	$189.30	$154.80	43
Kentucky	1,320	$208.42	$172.77	33
Alabama	1,246	$224.62	$188.28	31
Nevada	867	$213.41	$171.11	16
Mississippi	822	$203.39	$173.98	19
Montana	818	$159.14	$137.76	19
Nebraska	774	$289.10	$238.07	19
Oregon	752	$245.66	$185.37	31
New Hampshire	732	$173.50	$132.22	21
Arkansas	668	$241.34	$200.32	24
Delaware	533	$146.83	$137.11	18
District of Columbia	457	$226.94	$166.44	8
Maine	442	$167.95	$130.14	23
New Mexico	397	$224.85	$188.94	11
Idaho	382	$233.22	$194.12	10
North Dakota	328	$168.15	$127.98	12
West Virginia	293	$164.50	$130.63	18
South Dakota	289	$169.13	$132.93	9
Hawaii	235	$274.15	$191.54	6
Vermont	234	$166.26	$128.84	5
Rhode Island	171	$173.90	$128.44	7
ZZ	168	$167.91	$132.92	3
Puerto Rico	78	$301.49	$229.69	2
Alaska	68	$215.93	$161.79	3
Wyoming	30	$114.10	$133.92	1
AP	11	$354.12	$273.19	1

Related codes

G0439Annual wellness visit$117.95
G0444Annual depression screening$17.80
G0471Collection of venous blood by venipuncture or urine sample by catheter$10.56
G0442Annual alcohol misuse screening$17.96
G0480Drug test(s), definitive, utilizing (1) drug identification methods ab$110.33
G0483Drug test(s), definitive, utilizing (1) drug identification methods ab$240.71
G0482Drug test(s), definitive, utilizing (1) drug identification methods ab$193.45
G0481Drug test(s), definitive, utilizing (1) drug identification methods ab$152.51
G0438Annual wellness visit; includes a personalized prevention plan of serv$151.05
G0453Continuous intraoperative neurophysiology monitoring$32.00
G0446Annual, face-to-face intensive behavioral therapy for cardiovascular d$24.56
G0447Face-to-face behavioral counseling for obesity$24.83

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.