Billing code 10005: Ultrasound-guided FNAMedicare rate & RVUs in Illinois
Ultrasound-guided fine-needle aspiration biopsy of the first lesion, commonly used to sample a thyroid nodule, lymph node, or other accessible target.
Medicare pays $128.58–$140.35 for 10005 in the office in Illinois, from Rest Of Illinois to Chicago. 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 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.
Where 10005 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$128.58 to $140.35
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $140.35 | $70.19 |
| East St. Louis | $131.69 | $67.47 |
| Rest Of Illinois | $128.58 | $64.84 |
| Suburban Chicago | $139.12 | $67.43 |
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.
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
| 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
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%).
10005 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 10006FNA biopsy
- 10005 covers the first lesion sampled with ultrasound guidance. Use 10006 for each additional lesion sampled with that guidance.
- 10021Fine needle aspiration
- 10021 is for fine-needle aspiration biopsy without imaging guidance; 10005 includes ultrasound guidance.
- 10007Fine needle aspiration
- Both cover the first lesion, but 10007 uses fluoroscopic guidance rather than ultrasound.
- 10009FNA biopsy
- Both cover the first lesion, but 10009 uses CT guidance rather than ultrasound.
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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