However, a policy update published by Palmetto GBA last week has shed new light on the curious NCCI language, making it clear that it is Medicare's intent to require the use of these new G-codes for all prostate procedures anytime 5 or more separate specimen are billed. This new policy effectively caps reimbursement for all prostate biopsy specimens, irrespective of the manner in which they were collected.
For a laboratory or pathology practice that has typically billed for 12 specimens for the average prostate case, the Medicare reimbursement will effectively be reduced by 47% on global cases and by 58% for PC-only cases.