Effective March 2, 2026, surgical pathology for prostate biopsies, including gross and microscopic examinations, is covered and eligible for reimbursement consideration by AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) and AmeriHealth Administrators when the service is reported with Healthcare Common Procedure Coding System (HCPCS) code G0416. AmeriHealth and AmeriHealth Administrators do not reimburse surgical pathology for prostate biopsies when reported with Current Procedural Terminology (CPT®) code 88305.
This update applies to professional providers billing on a CMS-1500 claim form or the electronic equivalent, 837P, and outpa tient facility providers billing on a UB-04 claim form or the electronic equivalent, 837I.
This policy update will apply to the AmeriHealth and AmeriHealth Administrators Commercial and Medicare Advantage lines of business and supports our commitment to keeping health care affordable for members and customers.
Learn more
For more information about reimbursement of surgical pathology services for prostate biopsy, effective March 2, 2026, please refer to the following notification:
Note: The above policy notification links will expire and become unusable on March 2, 2026, when the new policy is issued.
To access the most updated version of any active policy, please refer to the Medical and Claim Payment Policy Portal or simply navigate to the Commercial or Medicare Advantage policy bulletins.
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