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    v1.0.30
    OpenPayerBilling CodesIncision Procedures on the ProstateCPT cpt-55711-mri-ultrasound-fusion-targeted-prostate-biopsy-first-lesion
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    CPT 55711: Transrectal MRI–Ultrasound Fusion Targeted Prostate Biopsy, First Lesion

    Medicare pays $381 on average nationally for this procedure.

    CPT code 55711 describes a transrectal prostate biopsy using MRI–ultrasound fusion to target a suspicious lesion; this code reports the first targeted lesion and represents a targeted transrectal prostate biopsy procedure typically performed in an outpatient surgical or radiology suite or other ambulatory setting where image-guided prostate biopsies are performed.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a man aged 55–75 with an elevated prostate-specific antigen (PSA) or an abnormal digital rectal exam who has a suspicious lesion identified on prostate magnetic resonance imaging (MRI). The patient is scheduled for a transrectal MRI–ultrasound fusion targeted prostate biopsy to sample the most suspicious lesion. The workflow includes pre-procedure counseling and consent, review of MRI images to identify target coordinates, bowel preparation and antimicrobial prophylaxis per facility protocol, positioning in left lateral decubitus or lithotomy, transrectal ultrasound (TRUS) acquisition, fusion of MRI targets with real-time ultrasound, and performance of a targeted core biopsy of the first suspicious lesion. Local anesthesia (periprostatic nerve block) is commonly administered. Post-procedure monitoring includes brief observation for bleeding, infection counseling, and instructions for return precautions. The specimen is submitted to pathology for histologic evaluation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    55700Biopsy, prostate; needle or punch, single or multiple, any approachGeneral prostate biopsy code for systematic or non-fusion biopsies; may be used for non-targeted cores performed during the same session.
    76942Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretationUsed to report ultrasound guidance for transrectal needle placement during the biopsy.
    88305Level IV surgical pathology, gross and microscopic examinationCommonly used for pathology reporting of prostate biopsy tissue per core.
    77021Magnetic resonance guidance for needle placement, interventional MRI guidanceRelevant when MRI guidance is used for targeting; may be used in facilities where MRI-based targeting is performed during the procedure.
    0376TMRI-guided prostate biopsy, including MRI interpretation and needle guidance, per lesion targeted (Category III)Related code for MRI-guided targeted prostate biopsy; may be used depending on technique and payer rules.
    99000Handling and/or conveyance of specimen for transfer from physician's office to a laboratoryMay be reported for specimen handling when applicable.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    58Modifier 58 (Staged or related procedure/service by the same physician during the postoperative period) indicates that a subsequent procedure performed by the same provider during the…- Use modifier 58 when the same physician/QHP performs a procedure during the postoperative/global period of an earlier procedure and the subsequent procedure is either planned or anticipated…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    363L00000X
    207K00000X
    163WI0600X
    103TE1100X
    207LA0401X
    1835C0205X
    2084A0401X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    C61Malignant neoplasm of prostate
    D72.829Elevated white blood cell count, unspecified
    D75.81Myelofibrosis
    E29.1Testicular hypofunction
    E29.9Testicular dysfunction, unspecified
    N40.0Benign prostatic hyperplasia without lower urinary tract symptoms
    N40.1Benign prostatic hyperplasia with lower urinary tract symptoms
    N40.2Nodular prostate without lower urinary tract symptoms
    N40.3Nodular prostate with lower urinary tract symptoms
    N41.9Inflammatory disease of prostate, unspecified

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

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

    CPT 55705: Prostate Tissue Sampling, Non‑Imaging Guided

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

    CPT 55706: Template-Guided Saturation Biopsy of Prostate

    CPT-55707-TRANSRECTAL-ULTRASOUND-GUIDED-PROSTATE-BIOPSY-SEXTANT

    CPT 55707: Transrectal Ultrasound-Guided Prostate Biopsy, Sextant and Targeted

    CPT-55708-PROSTATE-BIOPSY-TRANSRECTAL-US-FUSION-TARGETED-SEXTANT

    CPT 55708: Transrectal Ultrasound–Guided Prostate Biopsy with MRI Fusion

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

    CPT 55709: Perineal Ultrasound-Guided Prostate Biopsy

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

    CPT 55710: Transperineal Ultrasound‑Guided Sextant and Fusion Prostate Biopsy

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

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

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

    CPT 55713: Image-Guided Prostate Biopsy, Sextant and Targeted Sampling

    CPT-55714-IMAGE-GUIDED-TARGETED-PROSTATE-BIOPSY-CT-MRI

    CPT 55714: CT or MRI-Guided Targeted Prostate Biopsy

    CPT-55715-TARGETED-PROSTATE-BIOPSY-ADDITIONAL-LESION

    CPT 55715: Additional Targeted Prostate Lesion Biopsy

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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