CPT 60100 Thyroid Core Needle Biopsy Reimbursement | OpenPayer

Summary & Overview

CPT 60100: Image-Guided Thyroid Core Needle Biopsy

Headline: CPT code 60100: Image-guided core needle biopsy of the thyroid, a common diagnostic procedure.

Lead: CPT code 60100 represents an image-guided, automatic spring–powered core needle biopsy of the thyroid used to obtain tissue for pathologic diagnosis. The code matters nationally as thyroid nodules are common and accurate tissue diagnosis drives management decisions, impacting both surgical and non-surgical care pathways.

This report covers coverage and payment considerations for major national payers and Medicare. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, expected sites of service, common coding and billing considerations, and the types of benchmarks and policy updates typically relevant to this service. The summary highlights how payers approach outpatient image-guided procedures and what clinicians and coding teams should expect when documenting indications and imaging guidance.

What readers will learn: an overview of CPT code 60100 clinical purpose and service setting; which national payers are commonly relevant for coverage and payment; typical operational considerations for delivering this outpatient diagnostic procedure; and where to look for payer-specific policy updates and reimbursement benchmarks. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 60100thyroid biopsycore needle biopsyimage-guided procedureoutpatient procedurediagnostic pathologyprocedure codingbilling guidance

Billing Code Overview

CPT code 60100 describes a diagnostic procedure in which a provider obtains a tissue sample from the thyroid gland using an automatic, spring-powered core needle, typically performed under imaging guidance. This procedure is a core needle biopsy of the thyroid intended to collect a tissue specimen for histopathologic evaluation.

Service type: Image-guided core needle biopsy (diagnostic)
Typical site of service: Outpatient clinic, ambulatory surgery center, or hospital outpatient department where imaging guidance (such as ultrasound) and sterile procedure support are available.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 48-year-old woman presents to an outpatient endocrinology clinic with a palpable right thyroid nodule identified on routine exam and confirmed on ultrasound. The nodule measures 1.8 cm with mixed solid and cystic components and microcalcifications. The endocrinologist performs an ultrasound-guided core needle biopsy using an automatic spring-powered core needle to obtain tissue for histopathology and immunohistochemistry. Local anesthesia is given, real-time ultrasound is used for needle guidance, and 2 core samples are obtained. The specimen is sent to pathology with proper labeling and requisition. The patient is monitored in recovery for 30 minutes for bleeding or hematoma before discharge with instructions for wound care and return precautions.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day	Use when a distinct E/M visit is performed and documented on the same day as the biopsy (e.g., new patient history/exam).
`26`	Professional component	Use when billing only the physician professional component of an imaging-guided procedure when the facility bills the technical component separately.

CPT 60252: Total or Subtotal Thyroidectomy with Limited Neck Dissection

CPT-60240-TOTAL-THYROIDECTOMY

CPT 60240: Total Thyroidectomy

CPT-60225-NEAR-TOTAL-THYROIDECTOMY

CPT 60225: Near-Total Thyroidectomy

CPT-60200-THYROID-NODULE-EXCISION-OR-ISTHMUSECTOMY

CPT 60200: Removal of Thyroid Cyst or Incision of Thyroid Isthmus

CPT-60271-THYROIDECTOMY-SUBSTERNAL-EXTENSION

CPT 60271: Thyroidectomy with Substernal Extension

CPT-60254-TOTAL-OR-NEAR-TOTAL-THYROIDECTOMY-WITH-NECK-DISSECTION

CPT 60254: Total or Near-Total Thyroidectomy with Neck Dissection

CPT-60270-TOTAL-THYROIDECTOMY-WITH-MEDIASTINAL-EXTENSION

CPT 60270: Total Thyroidectomy with Mediastinal Extension

CPT-60210-THYROID-PARTIAL-LOBECTOMY-ISTHMUS-OPTIONAL

CPT 60210: Partial Thyroid Lobectomy, Isthmus Optional

CPT-60220-THYROID-LOBECTOMY-UNILATERAL

CPT 60220: Unilateral Thyroid Lobectomy

CPT-60281-SISTRUNK-PROCEDURE-THYROGLOSSAL-DUCT-CYST-EXCISION

CPT 60281: Sistrunk Procedure for Thyroglossal Duct Cyst Excision

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Taxonomy Code	Specialty	Notes
207RC0000X	Otolaryngology (ENT)	ENTs commonly perform thyroid biopsies, especially when surgical management is being considered.
207Q00000X	Family Medicine	Family physicians in some settings perform outpatient ultrasound-guided thyroid biopsies.
2080P0005X	Endocrinology	Endocrinologists commonly order and coordinate thyroid biopsy and may perform in specialized clinics.
207L00000X	General Surgery	General surgeons frequently perform thyroid biopsies in operative or outpatient procedural clinics.
207P00000X	Radiology	Interventional radiologists perform image-guided thyroid core biopsies when ultrasound guidance is used by radiology service.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10021`	Fine needle aspiration without imaging guidance	Alternative, less invasive sampling technique; may be performed instead of or prior to core biopsy.
`10022`	Fine needle aspiration with imaging guidance	Often used for cytologic sampling when imaging guidance is required; may be an alternative to core biopsy.
`76942`	Ultrasonic guidance for needle placement (real-time)	Performed concurrently to provide real-time ultrasound guidance during the core needle biopsy; often billed separately when criteria met.
`76937`	Ultrasound guidance for biopsy, localization, or placement of radiation therapy fields	Used when ultrasound guidance for biopsy is distinct and meets separate reporting criteria.
`88305`	Level IV surgical pathology, gross and microscopic examination	Typical pathology code level for core biopsy specimen processing and interpretation; billed by pathology for tissue obtained.

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