Summary & Overview
CPT 10006: Ultrasound-Guided Fine Needle Aspiration, Additional Lesion
CPT code 10006 denotes an ultrasound-guided fine needle aspiration (FNA) performed for an additional lesion sampled beyond the primary biopsy reported with 10005. Nationally, this code matters because it distinguishes additional lesion sampling from the primary procedure, affecting claim construction and reimbursement determinations for outpatient diagnostic services. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context for using 10006, the typical service setting for ultrasound-guided FNAs, and the role this code plays in billing when multiple lesions are biopsied. The publication covers payer coverage patterns and coding practice benchmarks, common modifiers encountered on claims, and practical claims-edit considerations relevant to multi-lesion sampling. The overview also highlights policy and documentation elements that frequently influence adjudication for additional-lesion FNA services, helping coding and revenue teams align claim submission with national payer expectations.
Billing Code Overview
CPT code 10006 describes a fine needle aspiration (FNA) biopsy performed for an additional lesion under ultrasound guidance. This code is reported for each additional tissue, cyst, or mass sampled when ultrasound guidance is used in conjunction with the primary code 10005.
Service Type: Diagnostic biopsy (ultrasound-guided fine needle aspiration)
Typical Site of Service: Outpatient clinics, radiology suites, ambulatory surgical centers, or other outpatient procedural settings where ultrasound guidance is available.
Clinical & Coding Specifications
Clinical Context
A 54-year-old woman presents to the outpatient radiology suite with a palpable 1.8 cm thyroid nodule identified on prior ultrasound and an additional 0.9 cm suspicious lateral neck lymph node. The ordering endocrinologist requests ultrasound-guided fine needle aspiration (FNA) of the dominant thyroid nodule and biopsy of the additional lymph node for cytologic diagnosis. The interventional radiologist performs the primary ultrasound-guided FNA of the dominant thyroid lesion (reported under 10005) and then performs a second ultrasound-guided FNA of the additional lymph node during the same encounter. The procedure workflow includes pre-procedure consent, ultrasound localization, local anesthetic, aspiration with a fine needle and syringe, immediate slide preparation (or specimen preservation for cytology), and documentation of lesions sampled. The encounter is typically performed in an outpatient radiology or hospital ambulatory procedure setting. Billing: report 10005 for the primary ultrasound-guided FNA and report 10006 for each additional lesion biopsied under ultrasound guidance during the same session.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure | When a distinct E/M visit is provided on the same day as the FNA and meets documentation requirements |
26 | Professional component | When reporting only the physician professional component separate from technical component (if applicable) |
59 | Distinct procedural service | When an additional, separate procedure or lesion is performed that is not normally reported together |
52 | Reduced services | When the service is partially reduced or not completed as originally intended |
51 | Multiple procedures | When multiple different procedures are performed at the same session and payer requires modifier for multiple procedures |
76 | Repeat procedure by same physician | When the same procedure is repeated later the same day by the same physician |
77 | Repeat procedure by another physician | When the same procedure is repeated by a different physician the same day |
22 | Increased procedural services | When work required is substantially greater than typically required and documented |
59 | Distinct procedural service | Use to indicate separate lesion biopsy when payer requires specific distinct service modifier |
XU | Unusual non-overlapping service component | When the service is distinct and separate from other services provided and meets X modifier documentation criteria |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RX0200X | Diagnostic Radiology | Interventional radiologists commonly perform ultrasound-guided FNAs |
| 207RC0000X | Radiology — Diagnostic | General diagnostic radiologists who perform ultrasound-guided biopsies |
| 207Q00000X | Interventional Radiology | Interventional radiology specialists performing image-guided FNAs |
| 2080P0005X | Endocrinology | Endocrinologists may perform or order thyroid FNAs and manage results |
| 363L00000X | Pathology | Pathologists or cytopathologists who interpret FNA specimens |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C73 | Malignant neoplasm of thyroid gland | Primary indication when a suspicious thyroid nodule requires cytologic diagnosis |
E04.1 | Nontoxic single thyroid nodule | Common benign-appearing thyroid nodule evaluated by FNA |
R22.1 | Localized swelling, mass and lump of neck | Clinical finding prompting ultrasound-guided FNA of neck masses |
C77.0 | Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck | Indication for lymph node FNA when metastatic disease is suspected |
D34 | Benign neoplasm of thyroid gland | Benign thyroid nodules requiring cytologic evaluation to confirm diagnosis |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
10005 | Fine needle aspiration; with imaging guidance (eg, ultrasound) with percutaneous imaging guidance for the first lesion | Primary code for the initial ultrasound-guided FNA during the encounter; 10006 is billed for each additional lesion |
20220 | Biopsy of parotid gland or external ear lesion; needle aspiration | May be used when FNAs target salivary gland lesions rather than superficial soft tissue masses |
10021 | Fine needle aspiration without imaging guidance; first lesion | Alternate code when FNA is performed without imaging guidance for the first lesion |
10022 | Fine needle aspiration without imaging guidance; each additional lesion | Companion to 10021 when multiple non-image-guided FNAs are performed |
76942 | Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation | Reported in some payer scenarios when separate ultrasound guidance is billed in addition to the FNA codes; payer rules vary |