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CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

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.

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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

Find policies, billing codes, payers, states, and providers

CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

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Sign up for cpt 55711 policy alerts

Get alerted when payer policies referencing 55711 are released or updated.

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Billing Code Overview

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 & 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.

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	Use when billing only the facility or equipment component separate from the physician’s professional work.
`50`	Bilateral Procedure	Not typically applicable for prostate biopsy; generally not used for this code.
`52`	Reduced Services	Use if the procedure was intentionally reduced or not completed as described.
`53`	Discontinued Procedure	Use if the procedure was started but discontinued due to extenuating circumstances.
`58`	Staged or Related Procedure or Service by Same Physician or Other Qualified Health Care Professional During the Postoperative Period	Use when a planned staged procedure is performed after the initial procedure during the global period.
`76`	Repeat Procedure by Same Physician or Other Qualified Health Care Professional	Use when the same physician repeats the biopsy on the same day.
`77`	Repeat Procedure by Another Physician or Other Qualified Health Care Professional	Use when another physician repeats the biopsy on the same day.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	Use when an unrelated procedure is performed during the global period.
`DX`	Diagnostic Service	Use where payer-specific modifier indicates diagnostic intent (payer dependent).

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.

CPT 55705: Non–Image-Guided Prostate Tissue Biopsy

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

CPT 55706: Template-Guided Transperineal Prostate Saturation Biopsy

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

CPT 55707: Transrectal Ultrasound-Guided Prostate Biopsy

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

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

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

CPT 55714: Image-Guided Targeted Prostate Biopsy (CT/MRI)

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

CPT 55715: Targeted Prostate Biopsy, Additional Lesion

Showing 1–10 of 12

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

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	Use when billing only the facility or equipment component separate from the physician’s professional work.
`50`	Bilateral Procedure	Not typically applicable for prostate biopsy; generally not used for this code.
`52`	Reduced Services	Use if the procedure was intentionally reduced or not completed as described.
`53`	Discontinued Procedure	Use if the procedure was started but discontinued due to extenuating circumstances.
`58`	Staged or Related Procedure or Service by Same Physician or Other Qualified Health Care Professional During the Postoperative Period	Use when a planned staged procedure is performed after the initial procedure during the global period.
`76`	Repeat Procedure by Same Physician or Other Qualified Health Care Professional	Use when the same physician repeats the biopsy on the same day.
`77`	Repeat Procedure by Another Physician or Other Qualified Health Care Professional	Use when another physician repeats the biopsy on the same day.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	Use when an unrelated procedure is performed during the global period.
`DX`	Diagnostic Service	Use where payer-specific modifier indicates diagnostic intent (payer dependent).

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.

CPT 55705: Non–Image-Guided Prostate Tissue Biopsy

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

CPT 55706: Template-Guided Transperineal Prostate Saturation Biopsy

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

CPT 55707: Transrectal Ultrasound-Guided Prostate Biopsy

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

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

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

CPT 55714: Image-Guided Targeted Prostate Biopsy (CT/MRI)

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

CPT 55715: Targeted Prostate Biopsy, Additional Lesion

Showing 1–10 of 12

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

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Billing Code Overview

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CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

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Billing Code Overview

CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

Sign up for cpt 55711 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 55711 represent?

Which CPT codes are commonly reported alongside 55711?

What modifiers are relevant when billing CPT 55711?

What is the typical clinical scenario and workflow for a procedure billed with 55711?

Which payers and policy considerations are highlighted for CPT 55711?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 55711 represent?

Which CPT codes are commonly reported alongside 55711?

What modifiers are relevant when billing CPT 55711?

What is the typical clinical scenario and workflow for a procedure billed with 55711?

Which payers and policy considerations are highlighted for CPT 55711?

References