How to choose: Select codes based on approach, guidance, and whether biopsy is systematic, targeted only, or systematic + targeted. The number of cores does not determine code selection.

Transrectal Approach

• 55707 – Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])
• 55708 – Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance, first targeted lesion
• 55711 – Biopsy, prostate, transrectal, MRI–ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion

Transperineal Approach

• 55709 – Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])
• 55710 – Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance biopsy, first targeted lesion
• 55712 – Biopsy, prostate, transperineal, MRI–ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion

In-Bore CT or MRI–Guided Biopsy

• 55713 – Biopsy, prostate, in-bore CT- or MRI-guided (ie, sextant), with biopsy of additional targeted lesion(s), first targeted lesion
• 55714 – Biopsy, prostate, in-bore CT- or MRI-guided targeted lesion(s) only, first targeted lesion

Add-On Code (Additional Targeted Lesions)

• 55715 – Each additional, MRI–ultrasound fusion or in-bore CT- or MRI-guided targeted lesion (List separately in addition to code for primary procedure)

Tip: Bill 55715 per additional targeted lesion (units reflect additional lesions), not per core.

Pair diagnosis codes with a clear indication in the documentation (e.g., elevated PSA, abnormal MRI, active surveillance).

• C61 – Malignant neoplasm of prostate
• N40.2 – Nodular prostate without lower urinary tract symptoms
• N40.3 – Nodular prostate with lower urinary tract symptoms
• R97.20 – Elevated PSA, unspecified
• R97.21 – Rising PSA following treatment for malignant neoplasm of prostate
• R93.89 – Abnormal findings on diagnostic imaging of other specified body structures
• Z85.46 – Personal history of malignant neoplasm of prostate

Modifier Use

• Modifier -22 may be appropriate when the procedure requires significantly more effort than usual (e.g., multiple difficult targets, complex anatomy, extended operative time). Support with specific detail in the op note.
• Modifier -52 may be considered in payer-specific scenarios when the service performed does not fully meet descriptor requirements. Support with clear documentation and payer guidance when available.

Global Period Awareness

• The 2026 prostate biopsy CPT codes (55707–55714) carry a 0-day global.
• CPT 55715 is an add-on (ZZZ) code and follows the global period of the primary procedure.

2026 Key Takeaways

• Cores do not drive coding — targets do.
• Approach + guidance + targeting determine CPT selection.
• MRI fusion requires true fusion technology (not cognitive targeting).
• 55715 units represent additional targeted lesions (not additional cores).

Facility reimbursement is often most sensitive to where the procedure occurred and what resources were required:

• Office/Clinic: Supplies and imaging resources may be captured differently than outpatient departments.
• ASC: Payment is typically procedure-based; confirm payer policy for fusion and transperineal workflows.
• HOPD: Packaging rules and departmental charging can affect reimbursement; in-bore workflows typically involve higher resource use.

Practical takeaway: Facility documentation should clearly support (1) approach, (2) guidance modality, and (3) targeted lesion count.

To reduce denials and miscoding, ensure the following elements are captured in the facility record:

• Approach: Transrectal vs transperineal (explicit language).
• Guidance modality: Ultrasound only vs MRI–ultrasound fusion vs in-bore CT/MRI.
• Targeting strategy: Systematic only vs targeted only vs systematic + targeted.
• Targeted lesion count: Number of distinct targeted lesions (supports add-on reporting where applicable).
• Fusion evidence (if used): Note fusion performed using a fusion platform/workstation (not cognitive targeting).
• In-bore evidence (if used): Imaging performed during the procedure with in-bore CT/MRI guidance.
• Anesthesia record: Type of anesthesia, start/stop times, staffing per facility protocol.
• Specimen chain: Labeling, number of containers, and transport documentation.

Why this matters: When the physician and facility records tell different stories, payers often default to denial or downcoding.

• Targets vs cores confusion: “12 cores” without “2 targeted lesions” creates denials. For 2026, lesion count matters.
• Fusion not supported: If documentation reads like cognitive targeting, expect denial when fusion is billed.
• In-bore ambiguity: In-bore guidance should be clearly supported by radiology/facility documentation.
• Units for additional lesions: Documentation should support number of additional lesions (not samples).
• Site-of-service mismatch: Confirm correct POS and departmental indicators (ASC vs HOPD vs clinic).

Bottom line: Clean claims start with clean clinical language: “fusion used” + “two targeted lesions biopsied.”

Facility billing is frequently affected by payer policy interpretations—especially during the first year of new codes.

• MRI–ultrasound fusion: Many payers expect documentation of a fusion platform/workstation workflow.
• In-bore CT/MRI: If using alternative MRI configurations, confirm payer interpretation and consider internal compliance review.
• Pre-authorization: Some payers require prior auth for MRI-guided pathways; ensure auth matches performed guidance.
• Record alignment: Physician op note + facility record + radiology documentation should match.

Recommendation: Track denials by payer early and keep a short internal “payer rules” addendum for scheduling/auth/coding alignment.

• The 2026 prostate biopsy CPT codes are structured with a 0-day global.
• Documentation still determines payability—global period does not replace payer coverage rules.