Summary & Overview
CPT 10011: MR-Guided Fine Needle Aspiration Biopsy, First Lesion
CPT code 10011 identifies a magnetic resonance (MR) imaging–guided fine needle aspiration (FNA) biopsy performed to obtain a diagnostic specimen from tissue, a cyst, or a mass. Nationally, this code matters because it captures image-guided diagnostic procedures that require MR suite access and interventional expertise and can affect facility and professional billing, resource allocation, and quality measurement for minimally invasive tissue sampling.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing overview of the procedure, typical sites of service, and which payers commonly reimburse MR-guided percutaneous FNA. The publication summarizes national benchmarks where available, highlights relevant policy updates affecting image-guided biopsies, and provides clinical context for when MR guidance is used versus other imaging modalities.
The report offers operational insights for coding and billing teams, revenue cycle leaders, and clinical program managers, including expected utilization scenarios and payer coverage patterns. Data not available in the input are noted explicitly where applicable.
Billing Code Overview
CPT code 10011 describes a fine needle aspiration (FNA) biopsy performed under magnetic resonance (MR) imaging guidance. The procedure involves using a specialized needle and syringe to collect a diagnostic specimen from tissue, a cyst, or a mass while the provider uses MR imaging to localize and guide the needle to the target lesion.
Service type: Image-guided diagnostic biopsy
Typical site of service: Hospital outpatient department or imaging center with MR capability, where MR guidance and interventional radiology or comparable specialty services are available.
Clinical & Coding Specifications
Clinical Context
A 56-year-old female presents with a palpable 2.5 cm breast mass identified on prior diagnostic mammography and targeted ultrasound. The lesion is suspicious for malignancy and requires tissue diagnosis. Under MR imaging guidance, the interventional radiologist performs a fine needle aspiration (FNA) of the lesion using a specialized needle and syringe to obtain cytology specimens. The patient is positioned in the MRI scanner, the lesion is localized with MR sequences, and sterile technique is used for percutaneous needle placement. A single lesion is aspirated; samples are placed in appropriate transport media and sent to cytopathology. Post-procedure imaging confirms no immediate complication and the patient is monitored in recovery before discharge with follow-up arranged for pathology results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | When no modifier is required and service is performed as usual |
22 | Increased procedural services | When the FNA requires substantially greater work, time, or complexity than typical due to difficult access or extensive localization |