Summary & Overview
CPT 55713: Image-Guided Prostate Biopsy, Sextant Plus Targeted Lesion
CPT code 55713 denotes an image-guided prostate biopsy performed within a CT or MRI scanner, combining systematic sextant sampling with targeted lesion biopsy. This procedure is important nationally due to increasing use of advanced imaging to improve prostate cancer detection and to guide precision sampling. The code captures services where imaging guidance is integral to both standard mapped sampling and focused targeting, distinguishing it from non-image-guided or exclusively transrectal ultrasound–guided biopsies.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find consolidated benchmarks for utilization and reimbursement patterns across major payers, clinical context on how imaging-guided targeted biopsies fit into contemporary prostate cancer diagnostic pathways, and policy considerations that affect coding and coverage for advanced imaging procedures. The publication also outlines coding nuances, typical sites of service, and gaps where additional payer-specific guidance may be needed. Data not available in the input are explicitly noted where applicable.
Billing Code Overview
CPT code 55713 describes a prostate biopsy performed inside a computed tomography (CT) or magnetic resonance imaging (MRI) scanner. The procedure uses real-time imaging guidance to obtain tissue samples from standard mapped areas of the prostate (sextants) and from a targeted lesion identified on imaging.
-
Service type: Image-guided prostate biopsy with both systematic (sextant) sampling and targeted lesion sampling.
-
Typical site of service: Hospital outpatient radiology or ambulatory imaging center with CT or MRI capability.
Data not available in the input regarding payers, modifiers, associated taxonomies, ICD-10 diagnoses, related codes, or service line.
Clinical & Coding Specifications
Clinical Context
A 66-year-old male with a rising prostate-specific antigen (PSA) and a prior abnormal multiparametric MRI demonstrating a 1.5 cm PIRADS 4 lesion in the right peripheral zone presents for image-guided prostate biopsy. The patient is positioned on the CT or MRI table; the radiologist or urologist performs real-time CT- or MRI-guided transperineal or transrectal sampling. The procedure includes systematic sampling of standard sextant locations and targeted sampling of the MRI-identified lesion under direct imaging guidance. Local anesthesia is administered and concurrent antibiotic prophylaxis is given per facility protocol. Specimens are labeled and sent to pathology for histologic evaluation. Post-procedure monitoring occurs in the recovery area until vitals are stable and the patient is discharged with post-biopsy instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician’s interpretation/technical component of an imaging-guided biopsy is split from the facility charge. |
TC | Technical component | When billing only the facility or equipment portion of the imaging guidance separate from the physician’s service. |