Summary & Overview
CPT 50205: Percutaneous Kidney Biopsy Sample Collection
CPT code 50205 denotes percutaneous collection of a kidney tissue sample via insertion of a collection needle for diagnostic biopsy. Nationally, this code represents an important diagnostic procedure used to evaluate renal disease, guide treatment decisions, and confirm histopathologic diagnoses. The procedure is typically performed under imaging guidance in ambulatory surgical centers or hospital outpatient departments and carries implications for clinical workflows, coding accuracy, and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 50205, typical sites of service, and the kinds of benchmarks and policy considerations that affect utilization and reimbursement. The publication outlines coding nuances to consider for claims processing, common modifier usage (listed elsewhere in the publication), and areas where payers frequently apply medical necessity reviews or prior authorization for renal biopsy procedures. The summary also highlights where data was not provided in the input, such as specific payer fee schedules, associated taxonomies, ICD-10 diagnoses, and related codes, and directs readers to the sections covering those items when available.
Billing Code Overview
CPT code 50205 describes a percutaneous kidney sampling procedure in which a physician inserts a collection needle into the kidney to obtain a sample for diagnostic biopsy. This procedure is a diagnostic, image-guided percutaneous kidney biopsy sampling intended to collect renal tissue for pathological analysis.
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Service type: Diagnostic percutaneous biopsy procedure
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Typical site of service: Ambulatory surgical center or hospital outpatient setting (image-guided procedure location)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred to interventional radiology or a urology team for a percutaneous renal mass sampling when imaging identifies a suspicious renal lesion. The patient often has a solitary renal mass discovered on ultrasound, CT, or MRI; indications include characterization of a solid renal mass, staging of suspected renal cell carcinoma, or evaluation of an atypical cystic lesion. Pre-procedure workflow includes review of imaging, assessment of anticoagulation status, informed consent, and coagulation testing. The procedure is performed with the patient positioned prone or in a decubitus position under conscious sedation or monitored anesthesia care. Under ultrasound or CT guidance, the physician advances a percutaneous needle into the renal cortex or mass, obtains core or aspiration samples, and submits specimens for pathology. Post-procedure monitoring includes vital signs, observation for hematuria or perinephric hematoma, and instructions on activity restriction and signs of complication. Typical site of service is an outpatient interventional radiology suite, ambulatory surgery center, or hospital-based procedure room. Service type: percutaneous diagnostic renal biopsy/needle aspiration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician's professional interpretation if separate technical component billed by facility. |