$383.08
Both describe MRI-ultrasound fusion biopsy of a first prostate lesion. Choose 55712 for transperineal access and 55711 for transrectal access.
On this page
CMS RVU26D · Effective 2026-10-01
55712 Prostate biopsy Medicare reimbursement rates in Colorado
Reports transperineal biopsy of a prostate lesion targeted by MRI-ultrasound fusion, for the first lesion sampled during the procedure. Compare 55712 office and facility rates across CMS payment localities in Colorado.
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.
What does Medicare pay for 55712 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$636.48
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$158.84
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urology procedure
About 55712: Transperineal MRI-ultrasound fusion prostate biopsy
Reports transperineal biopsy of a prostate lesion targeted by MRI-ultrasound fusion, for the first lesion sampled during the procedure.
A urologist uses MRI-ultrasound fusion to align a previously identified prostate target with real-time ultrasound, then obtains biopsy tissue through the perineum. The approach can be used when an MRI finding needs targeted tissue sampling; the needle route is through the skin between the scrotum and anus rather than through the rectum. The service is performed in an office or outpatient facility, depending on the clinician and setting.
Report this code for the first lesion targeted with the transperineal MRI-ultrasound fusion technique. Document the approach, fusion guidance, targeted lesion, and biopsy performed; additional lesions may be reported with the applicable add-on code. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 55712
- 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 RVU3.10 · 17%
- Practice expense (office) RVU14.66 · 81%
- Malpractice RVU0.41 · 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.
55712 compared with similar codes
Office rates for Colorado, from the same CMS release.
$609.50
This code is for transperineal biopsy with ultrasound guidance; 55712 identifies MRI-ultrasound fusion targeting.
$801.45
55713 describes in-bore CT or MRI-guided biopsy. This code is for MRI-ultrasound fusion guidance with transperineal access.
Compare 55712 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
$636.48
Facility
$158.84
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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 55712 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
6,368
- Code
- 55712
- Physician work
- 3.10
- Practice expense
- 14.66
- Malpractice
- 0.41
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.10 | × 1.012 | 3.1372 |
| Practice expense | 14.66 | × 1.064 | 15.5982 |
| Malpractice | 0.41 | × 0.781 | 0.3202 |
| Total RVUs | 19.0556 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$636.48
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.1 | 1.012 |
| Practice expense | 14.66 | 1.064 |
| Malpractice | 0.41 | 0.781 |
(3.1 × 1.012 + 14.66 × 1.064 + 0.41 × 0.781) × $33.4009 = $636.48
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.1 | 1.012 |
| Practice expense | 1.22 | 1.064 |
| Malpractice | 0.41 | 0.781 |
(3.1 × 1.012 + 1.22 × 1.064 + 0.41 × 0.781) × $33.4009 = $158.84
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.
55712 billing questions
How is this different from code 55711?
55712 is for the transperineal needle route. Code 55711 describes the corresponding MRI-ultrasound fusion biopsy performed transrectally.
Is the code reported per core or per lesion?
It identifies the first targeted lesion, not each biopsy core. Use the applicable additional-lesion code when more lesions are sampled.
Can modifier 50 be used for right- and left-sided targets?
No. Report the service without modifier 50; bilateral adjustment is inappropriate for this descriptor and anatomy.
Is same-day preoperative or postoperative care separately included?
The CMS global period is 0 days, and same-day preoperative and postoperative care is included in the procedure.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when the record documents medical necessity. Co-surgeon and team-surgery payment are not permitted.
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.
6,36555709,,Bx prst8 tprnl us guided,A,,3.23,13.77,,1.23,,0.42,17.42,4.88,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,36655710,,Bx prst8 tprn us w/mri fus 1,A,,3.81,15.24,,1.35,,0.48,19.53,5.64,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,36755711,,Bx prst8 trct mri-us 1st,A,,2.61,8.04,,1.10,,0.35,11.00,4.06,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,36855712,,Bx prst8 tprnl mri-us 1st,A,,3.10,14.66,,1.22,,0.41,18.17,4.73,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,36955713,,Bx prst8 in-bore ct/mri bx 1,A,,4.00,18.38,,1.06,,0.50,22.88,5.56,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37055714,,Bx prst8 in-bore ct/mri 1,A,,3.62,18.24,,0.98,,0.46,22.32,5.06,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,37155715,,Bx prst8 ea add mri-us/ct/mr,A,,1.05,1.24,,0.22,,0.14,2.43,1.41,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899