Summary & Overview
CPT 55714: Image-Guided Targeted Prostate Biopsy (CT/MRI)
CPT code 55714 represents an image-guided targeted prostate biopsy performed inside a CT or MRI scanner, using cross-sectional imaging to guide the needle to a lesion identified on imaging. This code captures a specialized diagnostic procedure increasingly used to improve lesion localization and diagnostic yield compared with non-targeted sampling. Nationally, the code matters as health systems and payers weigh the clinical value of targeted biopsies against costs and alternative approaches for prostate cancer diagnosis.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for image-guided targeted prostate biopsy, typical sites of service, and the types of benchmarks and coverage topics commonly examined for this service. The publication outlines expected service line placement within radiology or urology procedural workflows, summarizes common reimbursement and coding considerations where available, and highlights policy factors that influence payer coverage and utilization management. The content helps administrators, coding professionals, and clinicians understand where 55714 fits in diagnostic pathways and what operational and policy issues typically surround its use.
Data not available in the input for payer-specific rates, modifiers, taxonomies, ICD-10 pairings, and related codes.
Billing Code Overview
CPT code 55714 describes a prostate biopsy performed inside a CT or MRI scanner where the provider uses real-time imaging guidance to direct the biopsy needle to a targeted lesion. This procedure targets specific areas within the prostate identified on cross-sectional imaging to obtain tissue for diagnostic evaluation.
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Service type: Image-guided targeted prostate biopsy
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Typical site of service: Hospital outpatient imaging suite, ambulatory surgery center, or radiology department within a facility
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old man with a rising prostate-specific antigen (PSA) level and a suspicious lesion identified on prior multiparametric magnetic resonance imaging (mpMRI). He is referred to an interventional radiologist or urologist for image-guided targeted prostate biopsy. The clinical workflow begins with review of the mpMRI to localize the lesion(s). On the day of the procedure the patient is prepped and positioned inside the MRI or CT scanner. Conscious sedation or monitored anesthesia care is provided as appropriate. Real-time MRI or CT imaging is used to guide a transperineal or transrectal needle trajectory directly into the targeted lesion. Multiple cores are obtained from the targeted area, with additional systematic cores as determined by the clinician. Post-procedure imaging or ultrasound may be used to confirm needle position and assess immediate complications. The patient is observed for bleeding or urinary retention, given post-biopsy instructions including antibiotics and activity restrictions, and scheduled for follow-up to review pathology results and plan definitive management if clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s professional component separate from facility technical component, if applicable under payer rules. |
50 | Bilateral procedure | Use if procedure is documented and billed as bilateral when separate bilateral reporting is required (rare for targeted single-lesion biopsies).