CPT code 10005: Ultrasound-guided FNA, first lesion2026 Medicare rate & RVUs in Puerto Rico
Ultrasound-guided fine-needle aspiration biopsy of the first lesion, commonly used to sample a thyroid nodule, lymph node, or other accessible target.
In Puerto Rico, Medicare pays $133.05 for 10005 in the office and $62.48 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 10005 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 10005 covers
A clinician uses ultrasound to guide a fine needle into a lesion and aspirate cells or fluid for diagnostic evaluation. Common targets include thyroid nodules and enlarged lymph nodes; radiologists, endocrinologists, surgeons, and other clinicians may perform the procedure in an office or hospital setting. The code represents the first lesion sampled with ultrasound guidance, not a core-needle tissue biopsy.
Report 10005 for the first lesion and 10006 for each additional lesion sampled using ultrasound guidance during the session. The record should support the target lesion, ultrasound guidance, and performance of the aspiration. Ultrasound guidance is included in this service. When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and reduces payment for the others by 50%.
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 Puerto Rico compares for 10005
Across 109 of 109 payment localities, the office rate for 10005 runs from $118.35 in Arkansas to $169.84 in San Benito County, CA. Puerto Rico pays $133.05. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$133.05
- Los Angeles, CA · California$146.79+$13.74
- Washington, DC area · District of Columbia$149.56+$16.51
- Miami, FL · Florida$144.20+$11.15
- Chicago, IL · Illinois$140.35+$7.30
- Manhattan, NY · New York$151.45+$18.40
- Alaska · Alaska$158.58+$25.53
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $119.91 | $58.83 |
| ArkansasArkansas | $118.35 | $58.39 |
| ArizonaArizona | $129.00 | $61.35 |
| Bakersfield, CACalifornia | $138.55 | $62.04 |
| Chico, CACalifornia | $138.04 | $61.53 |
| El Centro, CACalifornia | $138.07 | $61.56 |
| Fresno, CACalifornia | $138.04 | $61.53 |
| Hanford, CACalifornia | $138.04 | $61.53 |
| Madera, CACalifornia | $138.04 | $61.53 |
| Merced, CACalifornia | $138.04 | $61.53 |
| Modesto, CACalifornia | $138.04 | $61.53 |
| Napa, CACalifornia | $157.63 | $65.63 |
| Oxnard, CACalifornia | $145.86 | $63.35 |
| Redding, CACalifornia | $138.04 | $61.53 |
| Rest of CaliforniaCalifornia | $138.04 | $61.53 |
| Riverside, CACalifornia | $139.89 | $63.38 |
| Sacramento, CACalifornia | $144.24 | $63.06 |
| Salinas, CACalifornia | $143.69 | $62.78 |
| San Diego, CACalifornia | $146.61 | $63.12 |
| Marin County, CACalifornia | $166.16 | $67.73 |
| San Francisco, CACalifornia | $165.96 | $67.53 |
| San Benito County, CACalifornia | $169.84 | $69.18 |
| Santa Clara County, CACalifornia | $169.05 | $68.39 |
| San Luis Obispo, CACalifornia | $141.44 | $61.93 |
| Santa Cruz, CACalifornia | $147.65 | $62.83 |
| Santa Maria, CACalifornia | $144.10 | $62.71 |
| Santa Rosa, CACalifornia | $149.10 | $63.38 |
| Stockton, CACalifornia | $138.04 | $61.53 |
| Vallejo, CACalifornia | $157.36 | $65.35 |
| Visalia, CACalifornia | $138.04 | $61.53 |
| Yuba City, CACalifornia | $138.04 | $61.53 |
| ColoradoColorado | $136.66 | $62.38 |
| ConnecticutConnecticut | $140.50 | $65.32 |
| DelawareDelaware | $130.98 | $62.01 |
| Fort Lauderdale, FLFlorida | $137.88 | $67.17 |
| Rest of FloridaFlorida | $131.64 | $64.90 |
| Atlanta, GAGeorgia | $134.82 | $63.89 |
| Rest of GeorgiaGeorgia | $124.81 | $62.54 |
| Hawaii, Guam, HIHawaii | $140.72 | $61.35 |
| IowaIowa | $122.12 | $58.24 |
| IdahoIdaho | $122.94 | $58.72 |
| East St. Louis, ILIllinois | $131.69 | $67.47 |
| Rest of IllinoisIllinois | $128.58 | $64.84 |
| Suburban Chicago, ILIllinois | $139.12 | $67.43 |
| IndianaIndiana | $123.57 | $58.86 |
| KansasKansas | $121.85 | $58.75 |
| KentuckyKentucky | $123.00 | $60.94 |
| New Orleans, LALouisiana | $128.37 | $62.68 |
| Rest of LouisianaLouisiana | $122.93 | $61.15 |
| Metropolitan Boston, MAMassachusetts | $148.94 | $65.59 |
| Rest of MassachusettsMassachusetts | $136.07 | $62.56 |
| Baltimore area, MDMaryland | $140.15 | $65.25 |
| Rest of MarylandMaryland | $133.23 | $62.58 |
| Rest of MaineMaine | $123.79 | $59.57 |
| Southern Maine, MEMaine | $129.46 | $60.28 |
| Detroit, MIMichigan | $133.39 | $66.03 |
| Rest of MichiganMichigan | $126.11 | $62.38 |
| MinnesotaMinnesota | $130.57 | $58.73 |
| Metropolitan Kansas City, MOMissouri | $127.31 | $61.76 |
| Metropolitan St. Louis, MOMissouri | $128.48 | $62.02 |
| Rest of MissouriMissouri | $121.20 | $61.02 |
| MississippiMississippi | $119.78 | $59.68 |
| MontanaMontana | $132.26 | $62.45 |
| North CarolinaNorth Carolina | $124.91 | $59.78 |
| North DakotaNorth Dakota | $128.89 | $59.09 |
| NebraskaNebraska | $122.64 | $58.21 |
| New HampshireNew Hampshire | $134.80 | $62.13 |
| Northern New JerseyNew Jersey | $148.31 | $67.33 |
| Rest of New JerseyNew Jersey | $142.00 | $65.77 |
| New MexicoNew Mexico | $126.84 | $62.82 |
| NevadaNevada | $131.40 | $61.52 |
| NYC suburbs and Long Island, NYNew York | $155.13 | $72.13 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $143.11 | $66.67 |
| Queens, NYNew York | $152.22 | $69.71 |
| Rest of New YorkNew York | $126.62 | $60.31 |
| OhioOhio | $125.43 | $61.69 |
| OklahomaOklahoma | $122.53 | $60.19 |
| Portland, OROregon | $140.36 | $62.80 |
| Rest of OregonOregon | $130.26 | $60.74 |
| Metropolitan Philadelphia, PAPennsylvania | $137.46 | $64.79 |
| Rest of PennsylvaniaPennsylvania | $125.46 | $61.38 |
| Rhode IslandRhode Island | $135.17 | $63.06 |
| South CarolinaSouth Carolina | $125.40 | $60.90 |
| South DakotaSouth Dakota | $128.50 | $58.69 |
| TennesseeTennessee | $122.44 | $58.98 |
| Austin, TXTexas | $136.31 | $62.45 |
| Beaumont, TXTexas | $124.74 | $61.21 |
| Brazoria, TXTexas | $130.69 | $61.51 |
| Dallas, TXTexas | $131.57 | $62.04 |
| Fort Worth, TXTexas | $130.85 | $62.02 |
| Galveston, TXTexas | $131.12 | $61.80 |
| Houston, TXTexas | $134.23 | $64.91 |
| Rest of TexasTexas | $127.68 | $61.43 |
| UtahUtah | $126.94 | $61.32 |
| VirginiaVirginia | $129.25 | $60.63 |
| Virgin Islands, VIUnited States Virgin Islands | $133.05 | $62.48 |
| VermontVermont | $128.67 | $59.56 |
| Rest of WashingtonWashington | $135.72 | $62.21 |
| King County, WAWashington | $151.57 | $65.92 |
| WisconsinWisconsin | $125.01 | $58.14 |
| West VirginiaWest Virginia | $124.34 | $63.68 |
| WyomingWyoming | $130.79 | $60.98 |
10005 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.
$118.35
$158.58
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 | $158.58 | 1 |
| AL | $119.91 | 1 |
| AR | $118.35 | 1 |
| AZ | $129.00 | 1 |
| CA | $138.04–$169.84 | 29 |
| CO | $136.66 | 1 |
| CT | $140.50 | 1 |
| DC | $149.56 | 1 |
| DE | $130.98 | 1 |
| FL | $131.64–$144.20 | 3 |
| GA | $124.81–$134.82 | 2 |
| GU | $140.72 | 1 |
| HI | $140.72 | 1 |
| IA | $122.12 | 1 |
| ID | $122.94 | 1 |
| IL | $128.58–$140.35 | 4 |
| IN | $123.57 | 1 |
| KS | $121.85 | 1 |
| KY | $123.00 | 1 |
| LA | $122.93–$128.37 | 2 |
| MA | $136.07–$148.94 | 2 |
| MD | $133.23–$149.56 | 3 |
| ME | $123.79–$129.46 | 2 |
| MI | $126.11–$133.39 | 2 |
| MN | $130.57 | 1 |
| MO | $121.20–$128.48 | 3 |
| MS | $119.78 | 1 |
| MT | $132.26 | 1 |
| NC | $124.91 | 1 |
| ND | $128.89 | 1 |
| NE | $122.64 | 1 |
| NH | $134.80 | 1 |
| NJ | $142.00–$148.31 | 2 |
| NM | $126.84 | 1 |
| NV | $131.40 | 1 |
| NY | $126.62–$155.13 | 5 |
| OH | $125.43 | 1 |
| OK | $122.53 | 1 |
| OR | $130.26–$140.36 | 2 |
| PA | $125.46–$137.46 | 2 |
| PR | $133.05 | 1 |
| RI | $135.17 | 1 |
| SC | $125.40 | 1 |
| SD | $128.50 | 1 |
| TN | $122.44 | 1 |
| TX | $124.74–$136.31 | 8 |
| UT | $126.94 | 1 |
| VA | $129.25–$149.56 | 2 |
| VI | $133.05 | 1 |
| VT | $128.67 | 1 |
| WA | $135.72–$151.57 | 2 |
| WI | $125.01 | 1 |
| WV | $124.34 | 1 |
| WY | $130.79 | 1 |
How the 10005 rate is calculated
Each of 10005’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 · 10005
RVUs × geographic indexes × conversion factor
Work1.42
1.42 RVUs× 1.000 GPCI
Practice expense2.37
2.37 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
3.9600
Conversion factor
$33.4009
Medicare rate
$132.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,061
- Code
- 10005
- Physician work
- 1.42
- Practice expense
- 2.37
- Malpractice
- 0.17
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.42 | × 1.000 | 1.4200 |
| Practice expense | 2.37 | × 1.011 | 2.3961 |
| Malpractice | 0.17 | × 0.985 | 0.1675 |
| Total RVUs | 3.9835 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$133.05
Office: (1.42 × 1 + 2.37 × 1.011 + 0.17 × 0.985) × $33.4009 = $133.05
Facility: (1.42 × 1 + 0.28 × 1.011 + 0.17 × 0.985) × $33.4009 = $62.48
Payment rules and modifiers for 10005
The CMS indicators that decide how 10005 is paid alongside other services.
CMS payment indicators · 10005
Ultrasound-guided FNA, first lesion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
10005 without 51 · national office
$132.27
Ultrasound-guided FNA, first lesion
10005-51 · Second procedure: 50%
$66.14
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 10005 has changed in Puerto Rico
10005 · Office / nonfacility
$133.05
Effective 2026-10-01
The base rate is $3.54 higher than on 2025-10-01, moving from $129.51 to $133.05 (2.7%).
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
$129.51changed to$133.05
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.46 changed to 1.42
- Malpractice RVU 0.16 changed to 0.17
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$134.61changed to$129.51
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.41 changed to 2.37
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$132.42changed to$134.61
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$138.49changed to$132.42
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.44 changed to 2.41
- Malpractice RVU 0.17 changed to 0.16
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$137.92changed to$138.49
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$142.84changed to$137.92
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 2.48 changed to 2.44
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$139.81changed to$142.84
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.38 changed to 2.48
- Malpractice RVU 0.15 changed to 0.17
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$132.99changed to$139.81
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.08 changed to 2.38
- Malpractice RVU 0.13 changed to 0.15
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$129.83changed to$132.99
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.98 changed to 2.08
- Malpractice RVU 0.15 changed to 0.13
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
No ratechanged to$129.83
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 | $133.05 | $62.48 | RVU26D |
| 2026-07-01 | $133.05 | $62.48 | RVU26C |
| 2026-04-01 | $133.05 | $62.48 | RVU26B |
| 2026-01-01 | $133.05 | $62.48 | RVU26A |
| 2025-10-01 | $129.51 | $70.22 | RVU25D |
| 2025-07-01 | $129.51 | $70.22 | RVU25C |
| 2025-04-01 | $129.51 | $70.22 | RVU25B |
| 2025-01-01 | $129.51 | $70.22 | RVU25A |
| 2024-10-01 | $134.61 | $71.93 | RVU24D |
| 2024-07-01 | $134.61 | $71.93 | RVU24C |
| 2024-04-01 | $134.61 | $71.93 | RVU24B |
| 2024-03-09 | $134.61 | $71.93 | RVU24AR |
| 2024-01-01 | $132.42 | $70.76 | RVU24A |
| 2023-10-01 | $138.49 | $73.93 | RVU23D |
| 2023-07-01 | $137.92 | $73.87 | RVU23C |
| 2023-04-01 | $137.92 | $73.87 | RVU23B |
| 2023-01-01 | $137.92 | $73.87 | RVU23A |
| 2022-10-01 | $142.84 | $75.16 | RVU22D |
| 2022-07-01 | $142.84 | $75.16 | RVU22C |
| 2022-04-01 | $142.84 | $75.16 | RVU22B |
| 2022-01-01 | $142.84 | $75.16 | RVU22A |
| 2021-10-01 | $139.81 | $73.69 | RVU21D |
| 2021-07-01 | $139.81 | $73.69 | RVU21C |
| 2021-04-01 | $139.81 | $73.69 | RVU21B |
| 2021-01-01 | $139.81 | $73.69 | RVU21A |
| 2020-10-01 | $132.99 | $74.79 | RVU20D |
| 2020-07-01 | $132.99 | $74.79 | RVU20C |
| 2020-04-01 | $132.99 | $74.79 | RVU20B |
| 2020-01-01 | $132.99 | $74.79 | RVU20A |
| 2019-10-01 | $129.83 | $75.75 | RVU19D |
| 2019-07-01 | $129.83 | $75.75 | RVU19C |
| 2019-04-01 | $129.83 | $75.75 | RVU19B |
| 2019-01-01 | $129.83 | $75.75 | 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 Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
10005 billing questions
When should 10005 be used instead of 10021?
Use 10005 when ultrasound guides the aspiration. Code 10021 describes fine-needle aspiration biopsy without imaging guidance.
How are additional lesions reported?
Report 10005 for the first lesion and 10006 for each additional lesion sampled with ultrasound guidance in the session. Count distinct lesions, not needle passes.
Can ultrasound guidance be billed separately?
No. Ultrasound guidance is included in 10005 for the aspiration it guides.
Does a core-needle biopsy qualify for 10005?
No. This code is for fine-needle aspiration, which collects cells or fluid; it does not describe a core-needle tissue biopsy.
What documentation supports reporting 10005?
Document the lesion sampled, the fine-needle aspiration, and use of ultrasound guidance. The record should distinguish the first lesion from any additional lesions reported with 10006.
How does CMS handle multiple procedures in the same session?
CMS pays the highest-valued procedure in full and reduces payment for the other procedures by 50% when multiple procedures are performed in the same session.
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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