Jonathan Rubenstein, MD1,2
1United Urology Group, Baltimore, Maryland
2 American Urological Association, Baltimore, Maryland
KEYWORDS:
Fee schedules; biopsy; clinical coding
Abstract
The Current Procedural Terminology (CPT) code set undergoes annual updates every January 1. For 2026, the prostate biopsy code set will expand from 3 codes to 11. In addition, CPT 55700 was deleted and new codes were added to allow for reporting of biopsy services by different approaches (transrectal, transperineal, in-gantry computed tomography or magnetic resonance imaging [MRI] guided) with or without MRI fusion or only by MRI fusion. An addon code can now be used to report additional targeted lesions. These new codes include all diagnostic imaging and imaging guidance when performed, meaning that 1 code will be used to report the entirety of the biopsy procedure.
The Current Procedural Terminology (CPT) code set undergoes updates on January 1 of each calendar year. For January 2026, the set will include new and updated category I codes that urologists will use, including a completely revamped code set for prostate biopsy services.1 This code set will increase from 3 codes (Table 1) to 11 codes (Table 2). In the new code, CPT 55700 (prostate biopsy, any technique) was deleted, and 9 codes were added to allow accurate reporting of biopsy services by various techniques (transrectal, transperineal, or in-gantry computed tomography [CT] or magnetic resonance imaging [MRI] guided), biopsy performed without or with MRI fusion, or biopsies performed only of targeted lesions by MRI fusion. There is also an add-on code used to report additional lesions biopsied with MRI or MRI fusion guidance after the first lesion. These codes include all diagnostic imaging and imaging guidance when performed, meaning 1 code will be used to report the entirety of the biopsy procedure as opposed to the possible multiple codes that were reported using the old code set.
CPT code 55700 is used for any type of prostate biopsy, except for incisional or saturation biopsy, including using the transrectal or transperineal approach. Because diagnostic imaging and imaging guidance are not part of this code, those services can be reported separately when performed. The code is reported once per session no matter how many cores are obtained, and there is no upper limit to the number of cores taken. The procedure can be performed in the nonfacility (office) or facility (ambulatory surgery center, hospital) setting. This procedure is a 0-day global procedure.
CPT code 55705 is reported when an open prostate biopsy is performed by surgical exposure of the prostate, with cores taken by direct visualization of the prostate. The work of this code includes obtaining tissue from the prostate by direct incisional sampling, and it specifically includes the need to make a surgical incision and tissue dissection to expose the prostate. The procedure can be performed in the facility (ambulatory surgery center, outpatient, or inpatient hospital) setting and is a 10-day global procedure.
CPT code 55706 is used to report the unique procedure of a saturation biopsy. A true saturation biopsy is performed for specific indications and following the steps defined by the American Medical Association (per CPT Assistant, November 2010):
The patient has a prior suspicious biopsy or a prior negative biopsy [result] with rising PSA [prostate-specific antigen].
The procedure is performed in an operating room under general or spinal anesthesia.
A template grid to map the (entire) prostate gland is used. This grid enables the physician to remove cores at 5-mm intervals using a stereotactic approach.
Cores are taken at 5-mm intervals, and each specimen is labeled to correspond with the location of each core chosen. In deeper planes, both a proximal and a distal biopsy may be obtained.
Each biopsy sample is marked for its coordinates, and all are mapped in 3D [3 dimensions] to determine the extent and exact position of malignant cells.
Typically, 35 to 60 biopsies are taken, based on the size of the gland.
CPT code 55706 tasks should not be performed in the office setting because there are no practice expense inputs to reimburse for supplies, clinical staff, or equipment. This is a 10-day global procedure, and imaging guidance is included, so imaging cannot be billed separately.
CPT codes 55700 and 76872 were found to be reported together more than 75% of the time; therefore, a combined code was needed. In addition, the code set was outdated because prostate biopsy techniques and equipment have changed. Accurate reporting and valuation for a health care professional’s time, effort, work, and equipment required unique and updated codes. For example, the additional time and practice expense of performing MRI fusion biopsies was not being appropriately captured, nor was the difference in time, effort, and equipment between transrectal and transperineal biopsies. Therefore, the new code set was created to have 1 code reported per biopsy procedure that would represent the work performed along with the imaging used (for diagnosis and for guidance) within the procedure being performed. Updated language includes the concept that in the typical biopsy grid, the prostate is divided into sextants (or regions), and multiple biopsies are typically taken from those regions. As a result, instructions and codes now clarify (1) that all prostate biopsy procedures are mutually exclusive, (2) the type of imaging included as part of the prostate biopsy procedure, and (3) that imaging guidance should not be reported separately when both imaging and biopsy are performed. To meet these goals, code 55700 was deleted, code 55705 was revised, and 9 new codes (55707-55715) were added to the code set to differentiate methods for obtaining prostate biopsies and provide guidance for these procedures:
Code 55705 was updated to be used to report any type of non–image-guided biopsy of the prostate.
Codes 55707 and 55709 are used to identify transrectal (55707) and transperineal (55709) biopsies obtained with ultrasound imaging only. The procedures represent identification of lesions and are intended for reporting any number of biopsies obtained with ultrasound as the mechanism of detection or guidance (ie, each code can be reported only once, regardless of the number of prostate biopsies obtained with ultrasound only). There is no use of predetermined areas for harvest of prostate gland tissue.
Codes 55708 and 55710 are used to identify transrectal (55708) and transperineal (55710) prostate biopsies performed under ultrasound for systematic, predetermined section biopsy of prostate tissue (ie, sextants) and MRI fusion for an additional targeted lesion of interest (ie, the first targeted lesion). Some of the biopsies for these procedures are harvested under ultrasound guidance from specified sections of the prostate gland (ie, the right apex, right mid, right base, left apex, left mid, left base). They include harvest of an additional lesion of interest using MRI fusion technology (ie, the technology uses the results of a previously acquired and reported MRI image and merges areas of interest from that MRI with real-time ultrasound imaging to target a lesion of interest that is then biopsied). If additional lesions are harvested under MRI fusion guidance, each additional lesion can be reported separately using add-on code 55715 for each additional lesion harvested using this method. Only the additional lesions targeted with MRI fusion guidance can be separately reported with 55715. Additional lesions targeted with ultrasound guidance are not separately reported.
Note: If any of the MRI fusion codes are reported, the fusion must take place on an independent workstation and be used to guide the biopsies. “Cognitive” fusion does not meet the definition of these codes because it does not require an independent workstation, nor is it specifically used to directly guide biopsies; therefore, cognitive fusion procedures should use codes such as 55707 and 55709.
Codes 55711 and 55712 are used to report transrectal (55711) and transperineal (55712) prostate biopsies performed under MRI fusion guidance of targeted lesions only. Unlike in codes 55708 and 55710, systematic ultrasound biopsy of sextant lesions is not involved in these services. Instead, these procedures include only biopsy of a first lesion targeted using the MRI fusion biopsy technique alone. If additional lesions are biopsied under MRI fusion guidance, then code 55715 is reported for each additional lesion biopsied under MRI fusion guidance.
Code 55713 is used to report prostate biopsy with in-bore CT or MRI for guidance for systematically targeted (ie, sextant [eg, right apex, right mid, right base]) lesions of the prostate and biopsy of an additional lesion of interest targeted with the CT or MRI device to guide the additional biopsy. Specifically, this code identifies use of CT or MRI not only to randomly select tissue from each predetermined sextant but also to harvest an additional lesion of interest. If additional lesions are targeted, then code 55715 can be reported to identify each additional lesion targeted in bore on the CT or MRI device.
Code 55714 is used to report prostate biopsy with in-bore CT or MRI for guidance for individual targeting and biopsy of a single lesion only (ie, the first lesion targeted with CT or MRI). This procedure does not include systematic biopsy of sextants. If additional lesions are targeted with CT or MRI, then code 55715 can be reported for each additional lesion biopsied using this technique.
Code +55715 is an add-on code used when additional lesions are obtained under either MRI fusion or in-bore CT or MRI guidance for targeted lesions.
Table 3 indicates which CPT codes should be reported based on the most common procedure scenarios, and Table 4 provides the proposed work relative value units and fees based on various sites of service for 2026.
Medicare and Medicaid programs; CY 2026 payment policies under the Physician Fee Schedule and other changes to Part B payment and coverage policies; Medicare Shared Savings Program requirements; and Medicare Prescription Drug Inflation Rebate Program. Fed Regist. 2025;90(134):32352-33261. To be codified at 42 CFR §§405, 410, 414, 424, 425, 427, 428, 495, and 512. Accessed September 1, 2025. https://www.federalregister.gov/documents/2025/07/16/2025-13271/medicare-and-medicaidprograms-cy-2026-payment-policies-under-the-physician-feeschedule-and-other
Published: December 19, 2025.
Conflict of Interest Disclosures: The author has nothing to disclose.
Funding/Support: None.
Author Contributions: J. Rubenstein is the sole author of this article.
Data Availability Statement: In this article, we do not report on, analyze, or generate any data.
Citation: Rubenstein J. 2026 Changes to prostate biopsy codes: what’s the deal with the new codes? Rev Urol. 2025;24(4):e75-e80.
Corresponding author: Jonathan Rubenstein, MD, United Urology Group, 6535 N Charles St, Suite 500, Baltimore, MD 21204 (jrubenstein@chesuro.com)