Summary & Overview
CPT 55715: Targeted Prostate Biopsy, Additional Lesion
CPT code 55715 is an add-on code for image-guided targeted prostate biopsy performed on an additional lesion beyond the initial target. It captures procedures that employ MRI–ultrasound fusion or in‑bore CT/MRI guidance to obtain tissue from a discrete prostate lesion. Nationally, accurate coding for targeted biopsy add-ons affects procedural reporting, quality measurement, and appropriate aggregation of diagnostic services for prostate cancer evaluation.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how payers typically recognize add-on image-guided biopsy services and how CPT code 55715 fits alongside primary biopsy codes.
Readers will learn the clinical context for using CPT code 55715, the typical sites of service where the procedure is performed, and the coding role of the add-on for each additional lesion sampled. The report summarizes benchmarks and reimbursement context at a national level, highlights policy considerations relevant to payers and providers, and clarifies documentation elements that support reporting this add-on code. Where input fields were not provided, this summary notes that specific payer policies, modifiers, taxonomies, and ICD-10 pairings are not available in the input.
Billing Code Overview
CPT code 55715 describes an add-on biopsy procedure for the prostate performed on an additional targeted lesion beyond the first. The procedure uses advanced image guidance, such as MRI–ultrasound fusion or in‑bore CT or MRI guidance, to localize and sample a specific lesion within the prostate.
Service type: Image-guided targeted prostate biopsy (additional lesion; add-on code)
Typical site of service: Hospital outpatient department or ambulatory surgery center; may also be performed in specialized radiology or urology procedural suites
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 65-year-old male with a rising prostate-specific antigen (PSA) and a prior multiparametric prostate MRI demonstrating two suspicious lesions undergoes targeted prostate biopsy using MRI–ultrasound fusion guidance. The urologist performs the initial targeted biopsy of the highest-risk lesion followed by an additional targeted biopsy of the second lesion during the same session. The procedure is performed in an outpatient ambulatory surgery center or radiology suite under local anesthesia with or without conscious sedation. Pre-procedure steps include informed consent, review of MRI images, registration of MRI to real-time transrectal ultrasound for fusion guidance, and sterile preparation. Post-procedure steps include hemostasis, brief observation for urinary retention or bleeding, and pathology submission of labeled cores. Billing includes the primary targeted lesion biopsy code for the first lesion and add-on code 55715 for each additional targeted lesion beyond the first.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
-26 | Professional component | Use when billing only the professional interpretation/management portion if the facility bills the technical component separately. |
-59 |