CPT code 10004: Fine needle aspiration, each additional lesion2026 Medicare rate & RVUs in Washington, DC area
Report this add-on for each additional lesion sampled by fine needle aspiration without imaging guidance after the first lesion in the same session.
In Washington, DC area, Medicare pays $59.05 for 10004 in the office and $39.77 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 10004 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Washington, DC area compares for 10004
Across 109 of 109 payment localities, the office rate for 10004 runs from $47.80 in Arkansas to $65.66 in Alaska. Washington, DC area pays $59.05. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Washington, DC area · this page$59.05
- Los Angeles, CA · California$56.87−$2.18
- Miami, FL · Florida$60.68+$1.63
- Chicago, IL · Illinois$59.03−$0.02
- Manhattan, NY · New York$61.00+$1.95
- Alaska · Alaska$65.66+$6.61
- Alabama · Alabama$48.38−$10.67
Other areas in District of Columbia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $47.80 | $33.74 |
| ArizonaArizona | $51.78 | $35.92 |
| Bakersfield, CACalifornia | $54.09 | $36.15 |
| Chico, CACalifornia | $53.72 | $35.78 |
| El Centro, CACalifornia | $53.74 | $35.80 |
| Fresno, CACalifornia | $53.72 | $35.78 |
| Hanford, CACalifornia | $53.72 | $35.78 |
| Madera, CACalifornia | $53.72 | $35.78 |
| Merced, CACalifornia | $53.72 | $35.78 |
| Modesto, CACalifornia | $53.72 | $35.78 |
| Napa, CACalifornia | $59.84 | $38.26 |
| Oxnard, CACalifornia | $56.33 | $36.99 |
| Redding, CACalifornia | $53.72 | $35.78 |
| Rest of CaliforniaCalifornia | $53.72 | $35.78 |
| Riverside, CACalifornia | $55.12 | $37.18 |
| Sacramento, CACalifornia | $55.73 | $36.70 |
| Salinas, CACalifornia | $55.51 | $36.54 |
| San Diego, CACalifornia | $56.35 | $36.78 |
| Marin County, CACalifornia | $62.55 | $39.47 |
| San Francisco, CACalifornia | $62.40 | $39.32 |
| San Benito County, CACalifornia | $64.00 | $40.40 |
| Santa Clara County, CACalifornia | $63.39 | $39.79 |
| San Luis Obispo, CACalifornia | $54.69 | $36.05 |
| Santa Cruz, CACalifornia | $56.52 | $36.64 |
| Santa Maria, CACalifornia | $55.59 | $36.51 |
| Santa Rosa, CACalifornia | $57.05 | $36.95 |
| Stockton, CACalifornia | $53.72 | $35.78 |
| Vallejo, CACalifornia | $59.62 | $38.05 |
| Visalia, CACalifornia | $53.72 | $35.78 |
| Yuba City, CACalifornia | $53.72 | $35.78 |
| ColoradoColorado | $53.92 | $36.51 |
| ConnecticutConnecticut | $56.29 | $38.66 |
| DelawareDelaware | $52.53 | $36.36 |
| Fort Lauderdale, FLFlorida | $56.91 | $40.33 |
| Rest of FloridaFlorida | $54.29 | $38.65 |
| Atlanta, GAGeorgia | $54.42 | $37.79 |
| Rest of GeorgiaGeorgia | $51.49 | $36.89 |
| Hawaii, Guam, HIHawaii | $54.39 | $35.78 |
| IowaIowa | $48.56 | $33.58 |
| IdahoIdaho | $49.00 | $33.95 |
| East St. Louis, ILIllinois | $55.69 | $40.64 |
| Rest of IllinoisIllinois | $53.58 | $38.63 |
| Suburban Chicago, ILIllinois | $57.26 | $40.45 |
| IndianaIndiana | $49.22 | $34.05 |
| KansasKansas | $48.77 | $33.98 |
| KentuckyKentucky | $50.22 | $35.67 |
| New Orleans, LALouisiana | $52.36 | $36.96 |
| Rest of LouisianaLouisiana | $50.31 | $35.83 |
| Metropolitan Boston, MAMassachusetts | $58.10 | $38.56 |
| Rest of MassachusettsMassachusetts | $53.85 | $36.61 |
| Baltimore area, MDMaryland | $56.21 | $38.65 |
| Rest of MarylandMaryland | $53.28 | $36.72 |
| Rest of MaineMaine | $49.65 | $34.59 |
| Southern Maine, MEMaine | $51.30 | $35.08 |
| Detroit, MIMichigan | $55.29 | $39.50 |
| Rest of MichiganMichigan | $51.69 | $36.75 |
| MinnesotaMinnesota | $50.71 | $33.87 |
| Metropolitan Kansas City, MOMissouri | $51.62 | $36.25 |
| Metropolitan St. Louis, MOMissouri | $52.03 | $36.45 |
| Rest of MissouriMissouri | $49.86 | $35.75 |
| MississippiMississippi | $48.82 | $34.73 |
| MontanaMontana | $53.10 | $36.73 |
| North CarolinaNorth Carolina | $50.02 | $34.75 |
| North DakotaNorth Dakota | $50.53 | $34.16 |
| NebraskaNebraska | $48.66 | $33.55 |
| New HampshireNew Hampshire | $53.50 | $36.46 |
| Northern New JerseyNew Jersey | $58.68 | $39.69 |
| Rest of New JerseyNew Jersey | $56.66 | $38.79 |
| New MexicoNew Mexico | $52.10 | $37.09 |
| NevadaNevada | $52.41 | $36.02 |
| NYC suburbs and Long Island, NYNew York | $62.79 | $43.33 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $57.35 | $39.43 |
| Queens, NYNew York | $60.83 | $41.48 |
| Rest of New YorkNew York | $50.68 | $35.13 |
| OhioOhio | $51.17 | $36.22 |
| OklahomaOklahoma | $49.71 | $35.09 |
| Portland, OROregon | $54.93 | $36.75 |
| Rest of OregonOregon | $51.73 | $35.43 |
| Metropolitan Philadelphia, PAPennsylvania | $55.35 | $38.31 |
| Rest of PennsylvaniaPennsylvania | $51.01 | $35.98 |
| Puerto RicoPuerto Rico | $53.29 | $36.75 |
| Rhode IslandRhode Island | $53.88 | $36.98 |
| South CarolinaSouth Carolina | $50.73 | $35.61 |
| South DakotaSouth Dakota | $50.22 | $33.86 |
| TennesseeTennessee | $49.03 | $34.15 |
| Austin, TXTexas | $53.98 | $36.67 |
| Beaumont, TXTexas | $50.76 | $35.86 |
| Brazoria, TXTexas | $52.16 | $35.94 |
| Dallas, TXTexas | $52.63 | $36.33 |
| Fort Worth, TXTexas | $52.46 | $36.33 |
| Galveston, TXTexas | $52.41 | $36.16 |
| Houston, TXTexas | $54.79 | $38.54 |
| Rest of TexasTexas | $51.53 | $36.00 |
| UtahUtah | $51.30 | $35.92 |
| VirginiaVirginia | $51.44 | $35.36 |
| Virgin Islands, VIUnited States Virgin Islands | $53.29 | $36.75 |
| VermontVermont | $50.74 | $34.53 |
| Rest of WashingtonWashington | $53.61 | $36.38 |
| King County, WAWashington | $58.77 | $38.69 |
| WisconsinWisconsin | $49.15 | $33.47 |
| West VirginiaWest Virginia | $52.00 | $37.78 |
| WyomingWyoming | $51.98 | $35.61 |
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.
The exact Washington, DC area inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,060
- Code
- 10004
- Physician work
- 0.78
- Practice expense
- 0.68
- Malpractice
- 0.13
GPCI2026.csv
39
- Locality
- Washington, DC area
- Physician work
- 1.054
- Practice expense
- 1.178
- Malpractice
- 1.113
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.78 | × 1.054 | 0.8221 |
| Practice expense | 0.68 | × 1.178 | 0.8010 |
| Malpractice | 0.13 | × 1.113 | 0.1447 |
| Total RVUs | 1.7678 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Washington, DC area$59.05
Office: (0.78 × 1.054 + 0.68 × 1.178 + 0.13 × 1.113) × $33.4009 = $59.05
Facility: (0.78 × 1.054 + 0.19 × 1.178 + 0.13 × 1.113) × $33.4009 = $39.77
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. |
How 10004 has changed in Washington, DC area
10004 · Office / nonfacility
$59.05
Effective 2026-10-01
The base rate is $0.95 higher than on 2025-10-01, moving from $58.10 to $59.05 (1.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$58.10changed to$59.05
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.80 changed to 0.78
- Practice expense RVU 0.67 changed to 0.68
- Work GPCI 1.057 changed to 1.054
- Practice expense GPCI 1.192 changed to 1.178
- Malpractice GPCI 1.168 changed to 1.113
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$58.60changed to$58.10
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.64 changed to 0.67
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$57.64changed to$58.60
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$58.31changed to$57.64
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.61 changed to 0.64
- Malpractice RVU 0.11 changed to 0.13
- Work GPCI 1.056 changed to 1.057
- Practice expense GPCI 1.214 changed to 1.192
- Malpractice GPCI 1.231 changed to 1.168
January 1, 2023
RVU23A
$59.77changed to$58.31
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.60 changed to 0.61
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.236 changed to 1.214
- Malpractice GPCI 1.294 changed to 1.231
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$59.83changed to$59.77
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.59 changed to 0.60
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$60.47changed to$59.83
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.57 changed to 0.59
- Work GPCI 1.049 changed to 1.054
- Practice expense GPCI 1.221 changed to 1.236
- Malpractice GPCI 1.277 changed to 1.294
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$60.32changed to$60.47
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.58 changed to 0.57
- Work GPCI 1.045 changed to 1.049
- Practice expense GPCI 1.205 changed to 1.221
- Malpractice GPCI 1.261 changed to 1.277
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
No ratechanged to$60.32
Held through RVU19B, RVU19C, RVU19D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $59.05 | $39.77 | RVU26D |
| 2026-07-01 | $59.05 | $39.77 | RVU26C |
| 2026-04-01 | $59.05 | $39.77 | RVU26B |
| 2026-01-01 | $59.05 | $39.77 | RVU26A |
| 2025-10-01 | $58.10 | $46.53 | RVU25D |
| 2025-07-01 | $58.10 | $46.53 | RVU25C |
| 2025-04-01 | $58.10 | $46.53 | RVU25B |
| 2025-01-01 | $58.10 | $46.53 | RVU25A |
| 2024-10-01 | $58.60 | $47.49 | RVU24D |
| 2024-07-01 | $58.60 | $47.49 | RVU24C |
| 2024-04-01 | $58.60 | $47.49 | RVU24B |
| 2024-03-09 | $58.60 | $47.49 | RVU24AR |
| 2024-01-01 | $57.64 | $46.71 | RVU24A |
| 2023-10-01 | $58.31 | $47.62 | RVU23D |
| 2023-07-01 | $58.31 | $47.62 | RVU23C |
| 2023-04-01 | $58.31 | $47.62 | RVU23B |
| 2023-01-01 | $58.31 | $47.62 | RVU23A |
| 2022-10-01 | $59.77 | $49.08 | RVU22D |
| 2022-07-01 | $59.77 | $49.08 | RVU22C |
| 2022-04-01 | $59.77 | $49.08 | RVU22B |
| 2022-01-01 | $59.77 | $49.08 | RVU22A |
| 2021-10-01 | $59.83 | $49.05 | RVU21D |
| 2021-07-01 | $59.83 | $49.05 | RVU21C |
| 2021-04-01 | $59.83 | $49.05 | RVU21B |
| 2021-01-01 | $59.83 | $49.05 | RVU21A |
| 2020-10-01 | $60.47 | $50.34 | RVU20D |
| 2020-07-01 | $60.47 | $50.34 | RVU20C |
| 2020-04-01 | $60.47 | $50.34 | RVU20B |
| 2020-01-01 | $60.47 | $50.34 | RVU20A |
| 2019-10-01 | $60.32 | $49.89 | RVU19D |
| 2019-07-01 | $60.32 | $49.89 | RVU19C |
| 2019-04-01 | $60.32 | $49.89 | RVU19B |
| 2019-01-01 | $60.32 | $49.89 | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Washington, DC area rate applies
Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.
- Washington
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
Show the CMS file lines behind this rate
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