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CMS RVU26D · Effective 2026-10-01

55713 in Merced

Office / nonfacility

$817.67

Base rate per service

Facility setting

$183.63

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Urology procedure

About 55713: In-bore image-guided prostate biopsy

Reports needle sampling of a prostate lesion under direct in-bore CT or MRI guidance, rather than ultrasound-guided or MRI-ultrasound fusion targeting.

A needle biopsy targets a prostate lesion while CT or MRI imaging is performed directly in the scanner. A urologist or radiologist may perform the procedure in a hospital or imaging setting when direct in-bore guidance is used to position the sampling needle. This method differs from MRI-ultrasound fusion, which uses ultrasound during biopsy and combines it with MRI information for targeting.

Report this code for the first lesion sampled using the in-bore CT/MRI approach. Documentation should identify the targeted lesion, guidance modality, biopsy approach, and sampling performed; report additional lesions with the applicable add-on code. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Do not use modifier 50 for paired anatomy. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

CMS billing rules for 55713

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Assistant at surgery is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU4.00 · 17%
  • Practice expense (office) RVU18.38 · 80%
  • Malpractice RVU0.50 · 2%

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.

55713 compared with similar codes

Office rates for Merced, from the same CMS release.

55711

Prostate biopsy

Transrectal fusion, first lesion

$389.25

Use 55711 for a transrectal biopsy guided by MRI-ultrasound fusion. This code is for direct in-bore CT or MRI guidance.

55712

Prostate biopsy

Transperineal fusion, first lesion

$649.31

Use 55712 for a transperineal biopsy guided by MRI-ultrasound fusion. This code describes direct in-bore CT or MRI guidance instead.

55715

Prostate biopsy

Each additional targeted lesion

$83.57

55715 is the add-on for each additional lesion in the applicable guidance family; this code reports the first lesion.

55707

Prostate biopsy

Transrectal, ultrasound guided

$361.37

55707 describes transrectal ultrasound-guided needle biopsy, not direct in-bore CT or MRI targeting.

The same code, a different location

How does Merced compare?

In Bakersfield, the office rate for 55713 is $819.16—$1.49 higher than the $817.67 rate in Merced. Both use the same code, release and participation basis.

55713 across payment areas

Same release and payment basis · bars start at $0

  1. Merced · This locality

    $817.67

  2. Bakersfield

    $819.16

    $1.49 higher than Merced

  3. Chico

    $817.67

    The same base rate than Merced

  4. El Centro

    $817.75

    $0.08 higher than Merced

  5. Fresno

    $817.67

    The same base rate than Merced

  6. Hanford-Corcoran

    $817.67

    The same base rate than Merced

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $876.42

    $58.75 higher than Merced

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 55713 ranges from $669.55 in Arkansas to $1042.51 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 55713

    Office

    $817.67

    Facility

    $183.63

    The same base rate than Merced for the office setting.

  • Modesto

    California · 55713

    Office

    $817.67

    Facility

    $183.63

    The same base rate than Merced for the office setting.

  • Napa

    California · 55713

    Office

    $959.64

    Facility

    $197.17

    $141.97 higher than Merced for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 55713

    Office

    $873.39

    Facility

    $189.60

    $55.72 higher than Merced for the office setting.

  • Redding

    California · 55713

    Office

    $817.67

    Facility

    $183.63

    The same base rate than Merced for the office setting.

  • Rest Of California

    California · 55713

    Office

    $817.67

    Facility

    $183.63

    The same base rate than Merced for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 55713

    Office

    $823.10

    Facility

    $189.06

    $5.43 higher than Merced for the office setting.

  • Sacramento-Roseville-Folsom

    California · 55713

    Office

    $861.34

    Facility

    $188.54

    $43.67 higher than Merced for the office setting.

  • Salinas

    California · 55713

    Office

    $858.22

    Facility

    $187.73

    $40.55 higher than Merced for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 55713

    Office

    $880.90

    Facility

    $189.01

    $63.23 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 55713

    Office

    $1019.57

    Facility

    $203.88

    $201.90 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 55713

    Office

    $1019.00

    Facility

    $203.31

    $201.33 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 55713

    Office

    $1042.51

    Facility

    $208.31

    $224.84 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 55713

    Office

    $1040.19

    Facility

    $205.98

    $222.52 higher than Merced for the office setting.

  • San Luis Obispo-Paso Robles

    California · 55713

    Office

    $844.07

    Facility

    $185.15

    $26.40 higher than Merced for the office setting.

  • Santa Cruz-Watsonville

    California · 55713

    Office

    $891.26

    Facility

    $188.38

    $73.59 higher than Merced for the office setting.

  • Santa Maria-Santa Barbara

    California · 55713

    Office

    $862.11

    Facility

    $187.58

    $44.44 higher than Merced for the office setting.

  • Santa Rosa-Petaluma

    California · 55713

    Office

    $900.44

    Facility

    $190.04

    $82.77 higher than Merced for the office setting.

  • Stockton

    California · 55713

    Office

    $817.67

    Facility

    $183.63

    The same base rate than Merced for the office setting.

  • Vallejo

    California · 55713

    Office

    $958.82

    Facility

    $196.35

    $141.15 higher than Merced for the office setting.

  • Visalia

    California · 55713

    Office

    $817.67

    Facility

    $183.63

    The same base rate than Merced for the office setting.

  • Yuba City

    California · 55713

    Office

    $817.67

    Facility

    $183.63

    The same base rate than Merced for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 55713

    Office

    $882.59

    Facility

    $201.11

    $64.92 higher than Merced for the office setting.

  • Miami

    Florida · 55713

    Office

    $814.92

    Facility

    $212.70

    $2.75 lower than Merced for the office setting.

  • Chicago

    Illinois · 55713

    Office

    $789.84

    Facility

    $208.45

    $27.83 lower than Merced for the office setting.

  • Manhattan

    New York · 55713

    Office

    $882.00

    Facility

    $209.78

    $64.33 higher than Merced for the office setting.

  • Alaska*

    Alaska · 55713

    Office

    $863.42

    Facility

    $247.31

    $45.75 higher than Merced for the office setting.

  • Alabama

    Alabama · 55713

    Office

    $680.23

    Facility

    $174.04

    $137.44 lower than Merced for the office setting.

  • Arkansas

    Arkansas · 55713

    Office

    $669.55

    Facility

    $172.62

    $148.12 lower than Merced for the office setting.

  • Arizona

    Arizona · 55713

    Office

    $742.78

    Facility

    $182.21

    $74.89 lower than Merced for the office setting.

  • Colorado

    Colorado · 55713

    Office

    $801.45

    Facility

    $185.92

    $16.22 lower than Merced for the office setting.

  • Connecticut

    Connecticut · 55713

    Office

    $817.66

    Facility

    $194.61

    $0.01 lower than Merced for the office setting.

  • Delaware

    Delaware · 55713

    Office

    $755.83

    Facility

    $184.27

    $61.84 lower than Merced for the office setting.

  • Fort Lauderdale

    Florida · 55713

    Office

    $785.69

    Facility

    $199.66

    $31.98 lower than Merced for the office setting.

  • Rest Of Florida

    Florida · 55713

    Office

    $745.60

    Facility

    $192.55

    $72.07 lower than Merced for the office setting.

  • Atlanta

    Georgia · 55713

    Office

    $777.79

    Facility

    $190.03

    $39.88 lower than Merced for the office setting.

  • Rest Of Georgia

    Georgia · 55713

    Office

    $701.12

    Facility

    $185.09

    $116.55 lower than Merced for the office setting.

  • Hawaii, Guam

    Hawaii · 55713

    Office

    $841.29

    Facility

    $183.53

    $23.62 higher than Merced for the office setting.

  • Iowa

    Iowa · 55713

    Office

    $701.96

    Facility

    $172.63

    $115.71 lower than Merced for the office setting.

  • Idaho

    Idaho · 55713

    Office

    $706.30

    Facility

    $174.08

    $111.37 lower than Merced for the office setting.

  • East St. Louis

    Illinois · 55713

    Office

    $732.03

    Facility

    $199.81

    $85.64 lower than Merced for the office setting.

  • Rest Of Illinois

    Illinois · 55713

    Office

    $720.20

    Facility

    $192.03

    $97.47 lower than Merced for the office setting.

  • Suburban Chicago

    Illinois · 55713

    Office

    $794.62

    Facility

    $200.49

    $23.05 lower than Merced for the office setting.

  • Indiana

    Indiana · 55713

    Office

    $710.81

    Facility

    $174.54

    $106.86 lower than Merced for the office setting.

  • Kansas

    Kansas · 55713

    Office

    $696.99

    Facility

    $174.03

    $120.68 lower than Merced for the office setting.

  • Kentucky

    Kentucky · 55713

    Office

    $694.65

    Facility

    $180.36

    $123.02 lower than Merced for the office setting.

  • New Orleans

    Louisiana · 55713

    Office

    $730.26

    Facility

    $185.89

    $87.41 lower than Merced for the office setting.

  • Rest Of Louisiana

    Louisiana · 55713

    Office

    $692.91

    Facility

    $180.94

    $124.76 lower than Merced for the office setting.

  • Metropolitan Boston

    Massachusetts · 55713

    Office

    $886.95

    Facility

    $196.22

    $69.28 higher than Merced for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 55713

    Office

    $795.50

    Facility

    $186.33

    $22.17 lower than Merced for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 55713

    Office

    $815.12

    Facility

    $194.39

    $2.55 lower than Merced for the office setting.

  • Rest Of Maryland

    Maryland · 55713

    Office

    $771.55

    Facility

    $186.10

    $46.12 lower than Merced for the office setting.

  • Rest Of Maine

    Maine · 55713

    Office

    $708.79

    Facility

    $176.56

    $108.88 lower than Merced for the office setting.

  • Southern Maine

    Maine · 55713

    Office

    $752.52

    Facility

    $179.23

    $65.15 lower than Merced for the office setting.

  • Detroit

    Michigan · 55713

    Office

    $754.18

    Facility

    $195.93

    $63.49 lower than Merced for the office setting.

  • Rest Of Michigan

    Michigan · 55713

    Office

    $712.96

    Facility

    $184.78

    $104.71 lower than Merced for the office setting.

  • Minnesota

    Minnesota · 55713

    Office

    $770.26

    Facility

    $174.98

    $47.41 lower than Merced for the office setting.

  • Metropolitan Kansas City

    Missouri · 55713

    Office

    $726.38

    Facility

    $183.17

    $91.29 lower than Merced for the office setting.

  • Metropolitan St. Louis

    Missouri · 55713

    Office

    $734.78

    Facility

    $184.04

    $82.89 lower than Merced for the office setting.

  • Rest Of Missouri

    Missouri · 55713

    Office

    $679.06

    Facility

    $180.39

    $138.61 lower than Merced for the office setting.

  • Mississippi

    Mississippi · 55713

    Office

    $674.52

    Facility

    $176.43

    $143.15 lower than Merced for the office setting.

  • Montana**

    Montana · 55713

    Office

    $764.18

    Facility

    $185.68

    $53.49 lower than Merced for the office setting.

  • North Carolina

    North Carolina · 55713

    Office

    $717.05

    Facility

    $177.31

    $100.62 lower than Merced for the office setting.

  • North Dakota**

    North Dakota · 55713

    Office

    $754.29

    Facility

    $175.79

    $63.38 lower than Merced for the office setting.

  • Nebraska

    Nebraska · 55713

    Office

    $706.55

    Facility

    $172.60

    $111.12 lower than Merced for the office setting.

  • New Hampshire

    New Hampshire · 55713

    Office

    $787.30

    Facility

    $185.07

    $30.37 lower than Merced for the office setting.

  • Northern Nj

    New Jersey · 55713

    Office

    $871.99

    Facility

    $200.93

    $54.32 higher than Merced for the office setting.

  • Rest Of New Jersey

    New Jersey · 55713

    Office

    $827.66

    Facility

    $195.93

    $9.99 higher than Merced for the office setting.

  • New Mexico

    New Mexico · 55713

    Office

    $716.61

    Facility

    $186.13

    $101.06 lower than Merced for the office setting.

  • Nevada**

    Nevada · 55713

    Office

    $762.04

    Facility

    $182.96

    $55.63 lower than Merced for the office setting.

  • Nyc Suburbs/Long Island

    New York · 55713

    Office

    $903.10

    Facility

    $215.26

    $85.43 higher than Merced for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 55713

    Office

    $832.05

    Facility

    $198.59

    $14.38 higher than Merced for the office setting.

  • Queens

    New York · 55713

    Office

    $891.88

    Facility

    $208.08

    $74.21 higher than Merced for the office setting.

  • Rest Of New York

    New York · 55713

    Office

    $728.56

    Facility

    $178.98

    $89.11 lower than Merced for the office setting.

  • Ohio

    Ohio · 55713

    Office

    $710.94

    Facility

    $182.76

    $106.73 lower than Merced for the office setting.

  • Oklahoma

    Oklahoma · 55713

    Office

    $694.80

    Facility

    $178.20

    $122.87 lower than Merced for the office setting.

  • Portland

    Oregon · 55713

    Office

    $830.22

    Facility

    $187.50

    $12.55 higher than Merced for the office setting.

  • Rest Of Oregon

    Oregon · 55713

    Office

    $756.80

    Facility

    $180.61

    $60.87 lower than Merced for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 55713

    Office

    $795.01

    Facility

    $192.79

    $22.66 lower than Merced for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 55713

    Office

    $712.95

    Facility

    $181.89

    $104.72 lower than Merced for the office setting.

  • Puerto Rico

    Puerto Rico · 55713

    Office

    $770.72

    Facility

    $185.85

    $46.95 lower than Merced for the office setting.

  • Rhode Island

    Rhode Island · 55713

    Office

    $785.21

    Facility

    $187.61

    $32.46 lower than Merced for the office setting.

  • South Carolina

    South Carolina · 55713

    Office

    $715.05

    Facility

    $180.51

    $102.62 lower than Merced for the office setting.

  • South Dakota**

    South Dakota · 55713

    Office

    $753.12

    Facility

    $174.62

    $64.55 lower than Merced for the office setting.

  • Tennessee

    Tennessee · 55713

    Office

    $700.61

    Facility

    $174.75

    $117.06 lower than Merced for the office setting.

  • Austin

    Texas · 55713

    Office

    $798.18

    Facility

    $186.13

    $19.49 lower than Merced for the office setting.

  • Beaumont

    Texas · 55713

    Office

    $707.78

    Facility

    $181.34

    $109.89 lower than Merced for the office setting.

  • Brazoria

    Texas · 55713

    Office

    $756.08

    Facility

    $182.79

    $61.59 lower than Merced for the office setting.

  • Dallas

    Texas · 55713

    Office

    $760.59

    Facility

    $184.40

    $57.08 lower than Merced for the office setting.

  • Fort Worth

    Texas · 55713

    Office

    $754.67

    Facility

    $184.26

    $63.00 lower than Merced for the office setting.

  • Galveston

    Texas · 55713

    Office

    $758.11

    Facility

    $183.66

    $59.56 lower than Merced for the office setting.

  • Houston

    Texas · 55713

    Office

    $767.26

    Facility

    $192.81

    $50.41 lower than Merced for the office setting.

  • Rest Of Texas

    Texas · 55713

    Office

    $731.28

    Facility

    $182.28

    $86.39 lower than Merced for the office setting.

  • Utah

    Utah · 55713

    Office

    $725.67

    Facility

    $181.88

    $92.00 lower than Merced for the office setting.

  • Virginia

    Virginia · 55713

    Office

    $748.87

    Facility

    $180.20

    $68.80 lower than Merced for the office setting.

  • Virgin Islands

    United States Virgin Islands · 55713

    Office

    $770.72

    Facility

    $185.85

    $46.95 lower than Merced for the office setting.

  • Vermont

    Vermont · 55713

    Office

    $749.82

    Facility

    $177.10

    $67.85 lower than Merced for the office setting.

  • Rest Of Washington

    Washington · 55713

    Office

    $794.50

    Facility

    $185.33

    $23.17 lower than Merced for the office setting.

  • Seattle (King Cnty)

    Washington · 55713

    Office

    $907.19

    Facility

    $197.37

    $89.52 higher than Merced for the office setting.

  • Wisconsin

    Wisconsin · 55713

    Office

    $726.87

    Facility

    $172.67

    $90.80 lower than Merced for the office setting.

  • West Virginia

    West Virginia · 55713

    Office

    $690.99

    Facility

    $188.27

    $126.68 lower than Merced for the office setting.

  • Wyoming**

    Wyoming · 55713

    Office

    $759.87

    Facility

    $181.37

    $57.80 lower than Merced for the office setting.

See how rates vary across the country

55713 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$669.55

$930.09

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$863.421
AL$680.231
AR$669.551
AZ$742.781
CA$817.67–$1,042.5129
CO$801.451
CT$817.661
DC$882.591
DE$755.831
FL$745.60–$814.923
GA$701.12–$777.792
GU$841.291
HI$841.291
IA$701.961
ID$706.301
IL$720.20–$794.624
IN$710.811
KS$696.991
KY$694.651
LA$692.91–$730.262
MA$795.50–$886.952
MD$771.55–$882.593
ME$708.79–$752.522
MI$712.96–$754.182
MN$770.261
MO$679.06–$734.783
MS$674.521
MT$764.181
NC$717.051
ND$754.291
NE$706.551
NH$787.301
NJ$827.66–$871.992
NM$716.611
NV$762.041
NY$728.56–$903.105
OH$710.941
OK$694.801
OR$756.80–$830.222
PA$712.95–$795.012
PR$770.721
RI$785.211
SC$715.051
SD$753.121
TN$700.611
TX$707.78–$798.188
UT$725.671
VA$748.87–$882.592
VI$770.721
VT$749.821
WA$794.50–$907.192
WI$726.871
WV$690.991
WY$759.871

Explore 55713 on the national rate map →

Where does this rate apply?

Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 55713 in Merced, the physician’s office rate is $817.67 and the facility-setting rate is $183.63: a difference of $634.04.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 55713 in Merced. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$899.44

$817.67 × 110% = $899.44

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 55713 in Merced.

PPRRVU2026_Oct_nonQPP.csv

6,369

Code
55713
Physician work
4.00
Practice expense
18.38
Malpractice
0.50

GPCI2026.csv

15

Locality
Merced
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 55713 in Merced
ComponentRVULocality factorAdjusted
Physician work4.00× 1.0174.0680
Practice expense18.38× 1.09620.1445
Malpractice0.50× 0.5360.2680
Total RVUs24.4805
Conversion factor× 33.4009

Office / nonfacility rate, Merced$817.67

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 55713 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work41.017
Practice expense18.381.096
Malpractice0.50.536

(4 × 1.017 + 18.38 × 1.096 + 0.5 × 0.536) × $33.4009 = $817.67

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work41.017
Practice expense1.061.096
Malpractice0.50.536

(4 × 1.017 + 1.06 × 1.096 + 0.5 × 0.536) × $33.4009 = $183.63

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

55713 · Office / nonfacility

$817.67

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    No ratechanged to$817.67

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: No rate

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$817.67$183.63RVU26D
2026-07-01$817.67$183.63RVU26C
2026-04-01$817.67$183.63RVU26B
2026-01-01$817.67$183.63RVU26A
2025-10-01Not in this releaseNot in this releaseRVU25D
2025-07-01Not in this releaseNot in this releaseRVU25C
2025-04-01Not in this releaseNot in this releaseRVU25B
2025-01-01Not in this releaseNot in this releaseRVU25A

55713 billing questions

How is this different from MRI-ultrasound fusion biopsy?

This code describes direct CT or MRI guidance with the patient positioned in the scanner. MRI-ultrasound fusion codes describe targeting that combines MRI information with ultrasound guidance.

How should additional lesions be reported?

This code covers the first lesion. Use the applicable add-on code, 55715, for each additional lesion when its requirements are met.

What documentation supports this code?

Document the lesion targeted, whether CT or MRI provided direct in-bore guidance, the biopsy approach, and the sampling performed.

Can modifier 50 be used for biopsies on both sides?

No. CMS identifies modifier 50 as inappropriate for this code; report the biopsy based on the documented procedure.

How does CMS handle other procedures performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in this code's 0-day global period.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 55713PPRRVU2026_Oct_nonQPP.csv, line 6,369 (RVU26D)
Geographic factors for MercedGPCI2026.csv, line 15 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet