CPT 55711 MRI–US Fusion Biopsy Reimbursement

CPT code 55711 denotes an image-guided transrectal prostate biopsy using MRI–ultrasound fusion to target a suspicious lesion, specifically reporting the first targeted lesion sampled. This procedure supports precision diagnosis of prostate cancer by combining prior MRI information with real-time ultrasound to improve lesion localization and sampling. Nationally, the code matters as use of targeted fusion biopsies grows with wider MRI adoption and evolving diagnostic pathways that prioritize lesion-directed sampling over systematic cores.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and use cases for MRI–ultrasound fusion targeted biopsy, typical sites of service, and how 55711 fits within procedural coding for prostate biopsy. The publication summarizes benchmarking and reimbursement context where available, highlights coding relationships with other prostate biopsy services, and outlines common policy considerations payers apply to coverage of MRI-guided targeted biopsies. This resource is intended to inform coding, billing workflows, and payer discussions at a national level without providing clinical recommendations.

Billing Code Overview

CPT code 55711 describes a transrectal prostate biopsy using MRI–ultrasound fusion to target a suspicious lesion. This code represents the service for the first targeted lesion sampled during the procedure.

Service type: Image-guided prostate biopsy targeting a specific lesion using MRI–ultrasound fusion
Typical site of service: Outpatient hospital or ambulatory surgical/office setting where image-guided prostate biopsy procedures are performed

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.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional Component	Use when billing only the physician’s interpretation component separate from technical facility services when applicable.
`TC`	Technical Component

Taxonomy Code	Specialty	Notes
`2084P0800X`	Urology	Urologists commonly perform MRI–TRUS fusion targeted prostate biopsies.
`2080S0123X`	Diagnostic Radiology	Radiologists often perform or interpret prostate MRI and may assist in fusion procedures.
`363L00000X`	Interventional Radiology	Interventional radiologists may perform image-guided prostate biopsies using fusion technology.
`207K00000X`	Family Medicine	Family physicians may arrange referral and pre-/post-procedure care but rarely perform the fusion biopsy themselves.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R97.2`	Elevated prostate specific antigen [PSA]	Common indication prompting MRI and targeted biopsy to evaluate for prostate cancer.
`N40.0`	Benign prostatic hyperplasia without lower urinary tract symptoms	May be present in patients undergoing evaluation; can cause PSA elevation and prompt further workup.
`N45.1`	Chronic prostatitis	Inflammatory conditions can cause PSA elevation and may be part of differential diagnosis prior to biopsy.
`C61`	Malignant neoplasm of prostate	Target diagnosis suspected when MRI shows suspicious lesion; biopsy confirms malignancy.
`R31.0`	Gross hematuria	Hematuria can prompt urologic evaluation including imaging and targeted biopsy if lesion suspected.
`N41.9`	Prostatitis, unspecified	Clinical relevance similar to chronic prostatitis; can influence PSA and biopsy decision-making.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55700`	Biopsy, prostate; needle or punch, single or multiple, any approach	General prostate biopsy code for systematic or non-fusion biopsies; may be used for non-targeted cores performed during the same session.
`76942`	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Used to report ultrasound guidance for transrectal needle placement during the biopsy.
`88305`	Level IV surgical pathology, gross and microscopic examination	Commonly used for pathology reporting of prostate biopsy tissue per core.
`77021`	Magnetic resonance guidance for needle placement, interventional MRI guidance	Relevant when MRI guidance is used for targeting; may be used in facilities where MRI-based targeting is performed during the procedure.
`0376T`	MRI-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.
`99000`	Handling and/or conveyance of specimen for transfer from physician's office to a laboratory	May be reported for specimen handling when applicable.

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Summary & Overview

CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy