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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.

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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.

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

CPT 55713: Image-Guided Prostate Biopsy, Sextant Plus Targeted Lesion

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Sign up for cpt 55713 policy alerts

Get alerted when payer policies referencing 55713 are released or updated.

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Billing Code Overview

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.
`59`	Distinct procedural service	When a separate, unrelated procedure is performed on the same day (use with caution for distinct biopsy sites).
`52`	Reduced services	When the procedure is partially reduced or not completed as documented (e.g., aborted targeting due to patient intolerance).
`77`	Repeat procedure by another physician	When an independent physician repeats the biopsy procedure for the same patient on the same day.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for complications during the postoperative period.
`79`	Unrelated procedure by the same physician during the postoperative period	When an unrelated procedure is performed during global period.
`GA`	Waiver of liability statement on file (no ABN required)	When an expectation of noncoverage exists and an advance waiver is documented (payer-specific use).
`Q0`	Investigational clinical service performed in a clinical research study that is non-covered	When the biopsy is performed under an investigational protocol with documented Q0 eligibility.
`Q3`	CT guidance for biopsy (historical/HCPCS context)	When facility-level reporting requires HCPCS guidance codes in conjunction with image-guided biopsy services.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Interventional Radiology	Radiologists frequently perform CT-guided or MRI-guided targeted prostate biopsies.
`208800000X`	Urology	Urologists perform transrectal/transperineal image-guided biopsies and coordinate pre/post care.
`207RD0003X`	Diagnostic Radiology	Diagnostic radiologists interpret MRI and perform image-guided interventions.
`363L00000X`	Pathology	Anatomic pathologists perform histologic evaluation of prostate biopsy cores.
`1835S0002X`	Nurse Practitioner	Advanced practice providers assist in pre-procedure evaluation and post-procedure follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N40.0`	Enlarged prostate with lower urinary tract symptoms	Common indication for prostate evaluation including biopsy if cancer is suspected.
`R97.2`	Elevated prostate specific antigen (PSA)	Primary laboratory trigger prompting prostate biopsy for cancer detection.
`N45.3`	Chronic prostatitis without abscess	May prompt evaluation including biopsy if focal lesion is identified on MRI that needs histologic clarification.
`C61`	Malignant neoplasm of prostate	Definitive diagnosis that is established by histologic examination of biopsy cores obtained during this procedure.
`N42.2`	Prostate specific antigen (PSA) abnormality, unspecified	Used when PSA abnormality is documented as the reason for biopsy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55700`	Biopsy, prostate; needle or punch, single or multiple, any approach	May be used for non-image-guided or office-based prostate biopsy when imaging guidance inside CT/MRI is not used.
`55866`	Laparoscopy, surgical prostatectomy, retropubic radical, with or without preservation of neurovascular bundles	Not directly linked but may be performed later if biopsy confirms clinically significant prostate cancer requiring definitive surgical management.
`77021`	Magnetic resonance guidance for needle placement	May be reported when MRI guidance is the primary imaging modality used to localize and guide needle placement for biopsy.
`77012`	Computed tomography guidance for needle placement	May be reported when CT guidance is used to localize and guide needle placement for biopsy.
`88305`	Level IV surgical pathology, gross and microscopic examination	Common pathology CPT code for evaluation of individual prostate biopsy cores once submitted to the laboratory.

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-55711-MRI-ULTRASOUND-FUSION-TARGETED-PROSTATE-BIOPSY-FIRST-LESION

CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

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

CPT 55712: Transperineal MRI–Ultrasound Fusion Prostate Biopsy, Single 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	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.
`59`	Distinct procedural service	When a separate, unrelated procedure is performed on the same day (use with caution for distinct biopsy sites).
`52`	Reduced services	When the procedure is partially reduced or not completed as documented (e.g., aborted targeting due to patient intolerance).
`77`	Repeat procedure by another physician	When an independent physician repeats the biopsy procedure for the same patient on the same day.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for complications during the postoperative period.
`79`	Unrelated procedure by the same physician during the postoperative period	When an unrelated procedure is performed during global period.
`GA`	Waiver of liability statement on file (no ABN required)	When an expectation of noncoverage exists and an advance waiver is documented (payer-specific use).
`Q0`	Investigational clinical service performed in a clinical research study that is non-covered	When the biopsy is performed under an investigational protocol with documented Q0 eligibility.
`Q3`	CT guidance for biopsy (historical/HCPCS context)	When facility-level reporting requires HCPCS guidance codes in conjunction with image-guided biopsy services.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Interventional Radiology	Radiologists frequently perform CT-guided or MRI-guided targeted prostate biopsies.
`208800000X`	Urology	Urologists perform transrectal/transperineal image-guided biopsies and coordinate pre/post care.
`207RD0003X`	Diagnostic Radiology	Diagnostic radiologists interpret MRI and perform image-guided interventions.
`363L00000X`	Pathology	Anatomic pathologists perform histologic evaluation of prostate biopsy cores.
`1835S0002X`	Nurse Practitioner	Advanced practice providers assist in pre-procedure evaluation and post-procedure follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N40.0`	Enlarged prostate with lower urinary tract symptoms	Common indication for prostate evaluation including biopsy if cancer is suspected.
`R97.2`	Elevated prostate specific antigen (PSA)	Primary laboratory trigger prompting prostate biopsy for cancer detection.
`N45.3`	Chronic prostatitis without abscess	May prompt evaluation including biopsy if focal lesion is identified on MRI that needs histologic clarification.
`C61`	Malignant neoplasm of prostate	Definitive diagnosis that is established by histologic examination of biopsy cores obtained during this procedure.
`N42.2`	Prostate specific antigen (PSA) abnormality, unspecified	Used when PSA abnormality is documented as the reason for biopsy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55700`	Biopsy, prostate; needle or punch, single or multiple, any approach	May be used for non-image-guided or office-based prostate biopsy when imaging guidance inside CT/MRI is not used.
`55866`	Laparoscopy, surgical prostatectomy, retropubic radical, with or without preservation of neurovascular bundles	Not directly linked but may be performed later if biopsy confirms clinically significant prostate cancer requiring definitive surgical management.
`77021`	Magnetic resonance guidance for needle placement	May be reported when MRI guidance is the primary imaging modality used to localize and guide needle placement for biopsy.
`77012`	Computed tomography guidance for needle placement	May be reported when CT guidance is used to localize and guide needle placement for biopsy.
`88305`	Level IV surgical pathology, gross and microscopic examination	Common pathology CPT code for evaluation of individual prostate biopsy cores once submitted to the laboratory.

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-55711-MRI-ULTRASOUND-FUSION-TARGETED-PROSTATE-BIOPSY-FIRST-LESION

CPT 55711: MRI–Ultrasound Fusion Targeted Transrectal Prostate Biopsy

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

CPT 55712: Transperineal MRI–Ultrasound Fusion Prostate Biopsy, Single 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.

OpenPayer

CPT 55713: Image-Guided Prostate Biopsy, Sextant Plus Targeted Lesion

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Billing Code Overview

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CPT 55713: Image-Guided Prostate Biopsy, Sextant Plus Targeted Lesion

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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 55713: Image-Guided Prostate Biopsy, Sextant Plus Targeted Lesion

Sign up for cpt 55713 policy alerts

Billing Code Overview

CPT 55713: Image-Guided Prostate Biopsy, Sextant Plus Targeted Lesion

Sign up for cpt 55713 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 55713 represent and where is this procedure typically performed?

Which modifiers are used when the professional and technical components of an image-guided prostate biopsy are billed separately?

Which related CPT codes might be reported alongside CPT 55713 for imaging guidance or pathology?

What diagnoses or clinical scenarios are associated with CPT 55713?

What modifiers or special codes should be considered for unusual billing situations related to CPT 55713?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 55713 represent and where is this procedure typically performed?

Which modifiers are used when the professional and technical components of an image-guided prostate biopsy are billed separately?

Which related CPT codes might be reported alongside CPT 55713 for imaging guidance or pathology?

What diagnoses or clinical scenarios are associated with CPT 55713?

What modifiers or special codes should be considered for unusual billing situations related to CPT 55713?

References