Billing code 55709: Prostate biopsyMedicare rate & RVUs

Medicare pays $581.84 for 55709 nationally in the office and $163.00 in a hospital or facility. Local office rates run $510.19–$790.49.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 55709 covers

A urologist typically performs this biopsy by passing a needle through the skin between the scrotum and anus into the prostate, using ultrasound to guide sampling. It may be performed in an office procedure room or a facility. The transperineal route accesses prostate tissue without passing the needle through the rectal wall; ultrasound guides the biopsy rather than MRI-ultrasound fusion.

Documentation should support the transperineal route, ultrasound guidance, the biopsy performed, and the clinical indication. This code represents the biopsy service, not a separate charge for each tissue core. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery is payable only when medical necessity is documented; co-surgeons and team surgery are not permitted.

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 55709 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

55709 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 55709 rate is calculated

Each of 55709’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.

Payment rules and modifiers for 55709

The CMS indicators that decide how 55709 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

55709 compared with similar codes

How to choose

55707Prostate biopsy

Choose 55709 when the biopsy needle enters through the perineum. Choose 55707 when the needle passes through the rectal wall under ultrasound guidance.

55710Prostate biopsy

55710 is the transperineal ultrasound-guided biopsy variant that uses MRI fusion; 55709 describes ultrasound guidance without MRI fusion.

55705Prostate biopsy

55705 covers prostate biopsy without imaging guidance. Use 55709 when ultrasound guides needle placement through the perineal route.

55706Prostate biopsy

55706 identifies needle saturation sampling. 55709 is selected for transperineal ultrasound-guided biopsy rather than on the basis of saturation sampling.

Codes related to 55709

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates