Billing code 55713: Prostate biopsyMedicare rate & RVUs in Illinois
Reports needle sampling of a prostate lesion under direct in-bore CT or MRI guidance, rather than ultrasound-guided or MRI-ultrasound fusion targeting.
Medicare pays $720.20–$794.62 for 55713 in the office in Illinois, from Rest Of Illinois to Suburban 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 55713 covers
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.
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 55713 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
$720.20 to $794.62
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $789.84 | $208.45 |
| East St. Louis | $732.03 | $199.81 |
| Rest Of Illinois | $720.20 | $192.03 |
| Suburban Chicago | $794.62 | $200.49 |
How the 55713 rate is calculated
Each of 55713’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 · 55713
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.00Practice expense 18.38Malpractice 0.50
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55713
The CMS indicators that decide how 55713 is paid alongside other services.
CMS payment indicators · 55713
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
55713 without 51 · national office
$764.21
Prostate biopsy
55713-51 · Second procedure: 50%
$382.11
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%).
55713 compared with similar codes
Compare codes
55713 vs 55711 vs 55712 vs 55715 vs 55707: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55711Prostate biopsy
- Use 55711 for a transrectal biopsy guided by MRI-ultrasound fusion. This code is for direct in-bore CT or MRI guidance.
- 55712Prostate biopsy
- Use 55712 for a transperineal biopsy guided by MRI-ultrasound fusion. This code describes direct in-bore CT or MRI guidance instead.
- 55715Prostate biopsy
- 55715 is the add-on for each additional lesion in the applicable guidance family; this code reports the first lesion.
- 55707Prostate biopsy
- 55707 describes transrectal ultrasound-guided needle biopsy, not direct in-bore CT or MRI targeting.
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 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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