CPT 55707 Transrectal Prostate Biopsy Reimbursement | OpenPayer

Summary & Overview

CPT 55707: Transrectal Ultrasound-Guided Prostate Biopsy

CPT code 55707 represents a transrectal ultrasound-guided prostate biopsy in which tissue is taken from standard sextant locations and from discrete ultrasound-identified lesions. This procedure is a common urologic diagnostic service used to evaluate suspected prostate cancer and guide clinical decision-making. Nationally, prostate biopsy volumes and reimbursement patterns influence access to diagnostic care, downstream pathology and oncology services, and resource utilization in ambulatory surgical centers and hospital outpatient departments. 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 55707, common sites of service, and what to expect in billing and coding workflows. The publication summarizes available national benchmarks and payer coverage landscapes when present, highlights relevant policy or coding updates that affect use of image-guided prostate biopsy codes, and situates 55707 within related urology procedure coding. This summary is intended to inform coding professionals, revenue cycle staff, and policy analysts about clinical scope, payer coverage considerations, and areas where additional documentation or coding clarity is often required. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare55707CPTprostate biopsytransrectal ultrasoundurologyimage-guided procedureambulatory surgeryoutpatient

Billing Code Overview

CPT code 55707 describes a prostate biopsy performed transrectally with ultrasound guidance. The provider obtains tissue samples from standard mapped areas of the prostate (sextant sampling) and from any discrete lesions visualized on ultrasound.

Service type: Image-guided diagnostic procedure (prostate biopsy)
Typical site of service: Ambulatory surgery center or hospital outpatient setting; may also be performed in an office procedure suite equipped for ultrasound-guided biopsies.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 64-year-old man with rising prostate-specific antigen (PSA) levels and abnormal findings on digital rectal exam is referred for ultrasound-guided transrectal prostate biopsy. The patient presents to an outpatient ambulatory surgical center; informed consent is obtained and allergies reviewed. Prophylactic antibiotics are given per facility protocol. The procedure is performed in the lithotomy or left lateral decubitus position under local anesthesia and periprostatic nerve block. A transrectal ultrasound probe is inserted to visualize the prostate; systematic sampling is obtained from standard sextant or extended mapping locations and additional targeted cores are taken from any discrete hypoechoic lesions identified on ultrasound. Specimens are labeled and sent to pathology. Post-procedure monitoring occurs for bleeding or urinary retention; discharge instructions include signs of infection and contact information. Typical site of service is an outpatient clinic, ambulatory surgery center, or hospital outpatient department.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a distinct E/M visit is documented and supports medical decision-making separate from the biopsy procedure.
`26`

CPT 55715: Targeted Prostate Biopsy, Additional Lesion

CPT-55706-TEMPLATE-GUIDED-TRANSPERINEAL-PROSTATE-SATURATION-BIOPSY

CPT 55706: Template-Guided Transperineal Prostate Saturation Biopsy

CPT-55705-PROSTATE-BIOPSY-NON-IMAGE-GUIDED

CPT 55705: Non–Image-Guided Prostate Tissue Biopsy

CPT-55712-TRANSPERINEAL-MRI-ULTRASOUND-FUSION-BIOPSY-SINGLE-LESION

CPT 55712: Transperineal MRI–Ultrasound Fusion Prostate Biopsy, Single Lesion

CPT-55713-IMAGE-GUIDED-PROSTATE-BIOPSY-SEXTANT-AND-TARGETED-LESION

CPT 55713: Image-Guided Prostate Biopsy, Sextant Plus Targeted Lesion

CPT-55709-TRANSPERINEAL-ULTRASOUND-GUIDED-PROSTATE-BIOPSY

CPT 55709: Transperineal Ultrasound-Guided Prostate Biopsy

CPT-55710-TRANSPERINEAL-ULTRASOUND-FUSION-PROSTATE-BIOPSY

CPT 55710: Transperineal Ultrasound-Guided Prostate Biopsy with MRI Fusion

CPT-55720-PROSTATE-INCISION-DRAINAGE-ABSCESS

CPT 55720: Incision and Drainage of Prostatic Abscess

CPT-55725-PROSTATIC-ABSCESS-DRAINAGE-INCISION

CPT 55725: Incision and Drainage of Prostatic Abscess

CPT-55711-MRI-ULTRASOUND-FUSION-TARGETED-PROSTATE-BIOPSY-FIRST-LESION

CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

Showing 1–10 of 12

Taxonomy Code	Specialty	Notes
2084P0800X	Urology	Urologists most commonly perform transrectal ultrasound-guided prostate biopsy.
207L00000X	Radiology	Interventional radiologists may perform image-guided prostate biopsies in some settings.
363LA2200X	Nurse Practitioner	Advanced practice providers in urology clinics may perform or assist with biopsies depending on state scope-of-practice.
363LP2300X	Physician Assistant	PAs in urology frequently assist or perform procedures under physician supervision.
207K00000X	Diagnostic Radiology	Radiologists providing ultrasound guidance or interpretation may be involved.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N40.0`	Enlarged prostate without lower urinary tract symptoms	Enlarged prostate may prompt evaluation including PSA monitoring and consideration of biopsy if cancer suspicion arises.
`N40.1`	Benign prostatic hyperplasia with lower urinary tract symptoms	BPH can coexist with concerns leading to biopsy when PSA or exam findings are abnormal.
`R97.20`	Elevated prostate specific antigen [PSA], unspecified	Elevated PSA is a primary indication for prostate biopsy to evaluate for malignancy.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging of prostate	Abnormal ultrasound or prior imaging findings may prompt targeted biopsy of discrete lesions.
`C61`	Malignant neoplasm of prostate	Biopsy is performed to confirm prostate cancer diagnosis and obtain histologic grading.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`76775`	Ultrasound, transrectal; prostate, diagnostic	May be billed when a diagnostic transrectal ultrasound is performed for visualization separate from the biopsy guidance, depending on payer rules.
`76942`	Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Often reported when separate ultrasound guidance is billed for needle placement; facility and physician billing rules determine use alongside biopsy code.
`88305`	Level IV surgical pathology, gross and microscopic examination	Common pathology CPT code used for evaluation of prostate core biopsy specimens; multiple units reported based on number of specimens.
`J3490`	Unclassified drugs (example for local anesthetic)	Used if specific drug codes for anesthetic or adjuncts are not available; documents use of periprostatic nerve block medications.
`P9612`	Infusion administration supply (example: procedural supplies)	Representative of supplies or device coding in facility billing; relates to consumables used during biopsy.

OpenPayer