Summary & Overview
CPT 55712: Transperineal MRI–Ultrasound Fusion Prostate Biopsy, Single Lesion
CPT code 55712 denotes a transperineal prostate biopsy performed with MRI–ultrasound fusion targeting a single suspicious lesion. The code captures the initial targeted-lesion sampling and is used in settings where MRI findings guide biopsy to improve detection of clinically significant prostate cancer. Nationally, use of image-fusion targeted biopsy has grown as MRI becomes more integrated into prostate cancer diagnostic pathways, making accurate coding for targeted procedures increasingly important for clinical documentation and claims processing.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical procedure and typical sites of service, along with what to expect from coding and billing perspectives when this code is used. The publication outlines benchmark considerations, common related services, and policy developments affecting image-guided prostate biopsy coding and coverage. It also provides clinical context about why MRI–ultrasound fusion targeting matters for diagnostic accuracy and how CPT code 55712 fits into broader prostate biopsy coding schemes.
Data not available in the input for payer-specific rates, modifiers, taxonomies, ICD-10 pairings, and related codes.
Billing Code Overview
CPT code 55712 describes a transperineal prostate biopsy using MRI–ultrasound fusion, targeting a single suspicious lesion. This service represents the procedure performed to obtain targeted tissue from the prostate guided by fusion of pre-procedure magnetic resonance imaging (MRI) with real-time ultrasound to localize and sample a lesion.
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Service type: Targeted image-guided prostate biopsy
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Typical site of service: Ambulatory surgical center or hospital outpatient setting
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Clinical & Coding Specifications
Clinical Context
A 64-year-old man with an elevated prostate-specific antigen (PSA) of 9.2 ng/mL and a prior negative transrectal biopsy undergoes multi-parametric prostate MRI that identifies a suspicious 1.2 cm lesion in the peripheral zone scored PI-RADS 4. The urologist schedules a transperineal MRI–ultrasound fusion targeted prostate biopsy to obtain cores from the suspicious lesion. The procedure is performed in an outpatient surgical center or hospital ambulatory surgery unit under local anesthesia with or without conscious sedation. A transperineal approach is chosen to reduce rectal flora contamination and improve sampling access to anterior or apical lesions. Imaging fusion software and real-time ultrasound guide the needle to the MRI-targeted lesion; 55712 is reported for the first targeted lesion sampled. The clinical workflow includes pre-procedure consent, image review and fusion setup, sterile perineal preparation, core acquisition from the targeted lesion(s), labeling of specimens, post-procedure monitoring, and pathology submission. Documentation should include lesion localization, number of targeted cores taken, fusion technique used, anesthesia type, and any immediate complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separately for the physician component of imaging performed in conjunction with the biopsy (rare for fusion guidance) |