Billing code 55714: Prostate biopsyMedicare rate & RVUs in Delaware
Reports prostate tissue sampling performed with the patient in a CT or MRI scanner, using in-bore imaging guidance to target a lesion.
Medicare pays $737.25 for 55714 in the office in Delaware (Delaware). Which amount applies depends on the service address.
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 9 sections
What 55714 covers
This service covers prostate tissue sampling performed with the patient in the CT or MRI scanner while imaging guides the biopsy needle to a targeted lesion. Urologists typically perform it in a hospital or other setting equipped for in-bore imaging and image-guided needle placement. It differs from MRI-ultrasound fusion biopsy, which uses ultrasound during sampling and combines it with previously acquired MRI information.
Report the code when the biopsy is performed using in-bore CT or MRI guidance; the operative report should identify the imaging method, targeted lesion, and tissue sampling performed. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur 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 for this service. Assistant-at-surgery payment requires documented medical necessity; 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.
55714 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $737.25 | $167.67 |
How the 55714 rate is calculated
Each of 55714’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 · 55714
RVUs × geographic indexes × conversion factor
Work3.62
3.62 RVUs× 1.000 GPCI
Practice expense18.24
18.24 RVUs× 1.000 GPCI
Malpractice0.46
0.46 RVUs× 1.000 GPCI
Adjusted RVUs
22.3200
Conversion factor
$33.4009
Medicare rate
$745.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 55714
The CMS indicators that decide how 55714 is paid alongside other services.
CMS payment indicators · 55714
Prostate biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| 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
55714 without 51 · national office
$745.51
Prostate biopsy
55714-51 · Second procedure: 50%
$372.76
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%).
55714 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 55713Prostate biopsy
- Both are in-bore CT or MRI-guided prostate biopsy codes. Distinguish them by the specific service represented in the operative documentation and the applicable code descriptor.
- 55715Prostate biopsy
- 55715 is for additional-lesion sampling with MRI-ultrasound fusion or CT/MRI guidance; this code represents the in-bore biopsy service rather than the additional-lesion add-on.
- 55711Prostate biopsy
- Use 55711 for transrectal MRI-ultrasound fusion guidance. This code describes biopsy performed in-bore under CT or MRI guidance.
55714 billing questions
How is this different from MRI-ultrasound fusion biopsy?
This code is for biopsy performed in-bore under CT or MRI guidance. MRI-ultrasound fusion biopsy uses ultrasound during sampling with MRI information fused for targeting.
What documentation supports reporting this code?
Document that sampling was performed with the patient in the CT or MRI scanner, the imaging modality used for guidance, and the targeted lesion and biopsy performed.
Is same-day postoperative care separately reported?
Same-day preoperative and postoperative care is included in the service's 0-day global period.
Can modifier 50 be used?
No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
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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