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    v1.0.30
    OpenPayerBilling CodesIncision Procedures on the ProstateCPT cpt-55713-image-guided-prostate-biopsy-sextant-and-targeted-lesion
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    CPT 55713: Image-Guided Prostate Biopsy, Sextant and Targeted Sampling

    Medicare pays $795 on average nationally for this procedure.

    CPT code 55713 describes an image-guided prostate biopsy performed inside a CT or MRI scanner, using cross-sectional imaging to obtain systematic samples from mapped sextants and targeted samples from a suspicious lesion; service type: image-guided prostate biopsy (transperineal or transrectal approach guided by CT or MRI) and typical site of service: inpatient/outpatient imaging suite within a hospital or ambulatory imaging center where CT or MRI guidance is available.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    Table of contents

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    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.

    Related CPT Codes

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

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    208800000X
    363L00000X
    207WX0110X
    364SF0001X
    146E00000X
    1041S0200X
    152WX0102X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    C61Malignant neoplasm of prostate
    D07.5Carcinoma in situ of prostate
    D40.0Neoplasm of uncertain behavior of prostate
    E29.1Testicular hypofunction
    E29.8Other testicular dysfunction
    N39.0Urinary tract infection, site not specified
    N40.0Benign prostatic hyperplasia without lower urinary tract symptoms
    N40.1Benign prostatic hyperplasia with lower urinary tract symptoms
    N40.2Nodular prostate without lower urinary tract symptoms
    N40.3Nodular prostate with lower urinary tract symptoms

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-55705-PROSTATE-BIOPSY-NON-IMAGE-GUIDED

    CPT 55705: Prostate Tissue Sampling, Non‑Imaging Guided

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

    CPT 55706: Template-Guided Saturation Biopsy of Prostate

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

    CPT 55707: Transrectal Ultrasound-Guided Prostate Biopsy, Sextant and Targeted

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

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

    CPT-55709-TRANSPERINEAL-ULTRASOUND-GUIDED-PROSTATE-BIOPSY

    CPT 55709: Perineal Ultrasound-Guided Prostate Biopsy

    CPT-55710-TRANSPERINEAL-ULTRASOUND-FUSION-PROSTATE-BIOPSY

    CPT 55710: Transperineal Ultrasound‑Guided Sextant and Fusion Prostate Biopsy

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

    CPT 55711: Transrectal MRI–Ultrasound Fusion Targeted Prostate Biopsy, First Lesion

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

    CPT 55712: Transperineal MRI–Ultrasound Fusion Targeted Prostate Biopsy, First Lesion

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

    CPT 55714: CT or MRI-Guided Targeted Prostate Biopsy

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

    CPT 55715: Additional Targeted Prostate Lesion Biopsy

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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