CPT code 10004: Fine needle aspiration, each additional lesion2026 Medicare rate & RVUs
Report this add-on for each additional lesion sampled by fine needle aspiration without imaging guidance after the first lesion in the same session.
Medicare pays $53.11 for 10004 nationally in the office and $36.74 in a hospital or facility. Local office rates run $47.80–$65.66.
Medicare rate · 10004
Fine needle aspiration, each additional lesion
- Work RVUs
- 0.78
- Total RVUs
- 1.59
- Global days
- ZZZ
National rate · 2026
$53.11
Office setting, before claim adjustments.
See every locality for 10004 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 10004 covers
A clinician uses a fine needle to sample cells or fluid from an additional lesion without imaging guidance, typically by locating the target through palpation. This may be performed by a physician such as a surgeon, endocrinologist, radiologist, or other clinician who evaluates or treats palpable masses in an office, clinic, or hospital setting. Common targets include palpable thyroid nodules, lymph nodes, and soft-tissue masses when the clinician samples more than one distinct lesion during the session.
Use 10004 for each additional lesion after reporting 10021 for the first lesion sampled without imaging guidance. Count distinct lesions, not needle passes or specimen containers, and document the location of each lesion and the sampling performed. If ultrasound, fluoroscopy, CT, or MR guidance is used, select the code family for that guidance method instead. As an add-on code, 10004 is billed only with a primary procedure and is paid within that procedure’s global period.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 10004 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$47.80 to $65.66
109 of 109 payment localities
10004 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$47.80
$65.66
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $65.66 | 1 |
| AL | $48.38 | 1 |
| AR | $47.80 | 1 |
| AZ | $51.78 | 1 |
| CA | $53.72–$64.00 | 29 |
| CO | $53.92 | 1 |
| CT | $56.29 | 1 |
| DC | $59.05 | 1 |
| DE | $52.53 | 1 |
| FL | $54.29–$60.68 | 3 |
| GA | $51.49–$54.42 | 2 |
| GU | $54.39 | 1 |
| HI | $54.39 | 1 |
| IA | $48.56 | 1 |
| ID | $49.00 | 1 |
| IL | $53.58–$59.03 | 4 |
| IN | $49.22 | 1 |
| KS | $48.77 | 1 |
| KY | $50.22 | 1 |
| LA | $50.31–$52.36 | 2 |
| MA | $53.85–$58.10 | 2 |
| MD | $53.28–$59.05 | 3 |
| ME | $49.65–$51.30 | 2 |
| MI | $51.69–$55.29 | 2 |
| MN | $50.71 | 1 |
| MO | $49.86–$52.03 | 3 |
| MS | $48.82 | 1 |
| MT | $53.10 | 1 |
| NC | $50.02 | 1 |
| ND | $50.53 | 1 |
| NE | $48.66 | 1 |
| NH | $53.50 | 1 |
| NJ | $56.66–$58.68 | 2 |
| NM | $52.10 | 1 |
| NV | $52.41 | 1 |
| NY | $50.68–$62.79 | 5 |
| OH | $51.17 | 1 |
| OK | $49.71 | 1 |
| OR | $51.73–$54.93 | 2 |
| PA | $51.01–$55.35 | 2 |
| PR | $53.29 | 1 |
| RI | $53.88 | 1 |
| SC | $50.73 | 1 |
| SD | $50.22 | 1 |
| TN | $49.03 | 1 |
| TX | $50.76–$54.79 | 8 |
| UT | $51.30 | 1 |
| VA | $51.44–$59.05 | 2 |
| VI | $53.29 | 1 |
| VT | $50.74 | 1 |
| WA | $53.61–$58.77 | 2 |
| WI | $49.15 | 1 |
| WV | $52.00 | 1 |
| WY | $51.98 | 1 |
How the 10004 rate is calculated
Each of 10004’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 10004
RVUs × geographic indexes × conversion factor
Work0.78
0.78 RVUs× 1.000 GPCI
Practice expense0.68
0.68 RVUs× 1.000 GPCI
Malpractice0.13
0.13 RVUs× 1.000 GPCI
Adjusted RVUs
1.5900
Conversion factor
$33.4009
Medicare rate
$53.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 10004
The CMS indicators that decide how 10004 is paid alongside other services.
CMS payment indicators · 10004
Fine needle aspiration, each additional lesion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
10004 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 10021Fine needle aspirationFirst lesion, no imaging
- 10021 covers the first lesion sampled without imaging guidance; 10004 covers each additional lesion sampled in the same session.
- 10006FNA biopsyEach additional lesion
- Both describe sampling an additional lesion, but 10006 is for ultrasound-guided sampling; 10004 is for sampling without imaging guidance.
- 10008FNA biopsyEach additional lesion
- 10008 is for each additional lesion sampled with fluoroscopic guidance. Use 10004 when no imaging guidance is used.
10004 billing questions
When should 10004 be reported instead of 10021?
Report 10021 for the first lesion sampled without imaging guidance. Report 10004 for each additional distinct lesion sampled in the same session.
Can 10004 be billed by itself?
No. It is an add-on code and must be reported with a primary procedure; for unguided sampling, the primary code is 10021.
How are units determined?
Count each additional distinct lesion sampled, not the number of needle passes or specimens from one lesion. Documentation should identify each lesion and the sampling performed.
Which code applies when imaging guides the additional biopsy?
Use the additional-lesion code for the guidance method used: 10006 for ultrasound, 10008 for fluoroscopy, 10010 for CT, or 10012 for MR guidance.
How does the global period affect payment?
CMS treats 10004 as an add-on paid within the primary procedure’s global period. Report it with the primary procedure rather than as a standalone service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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