$335.83
Use 55711 for a transrectal biopsy guided by MRI-ultrasound fusion. This code is for direct in-bore CT or MRI guidance.
On this page
CMS RVU26D · Effective 2026-10-01
55713 Prostate biopsy Medicare reimbursement rates in Kansas
Reports needle sampling of a prostate lesion under direct in-bore CT or MRI guidance, rather than ultrasound-guided or MRI-ultrasound fusion targeting. Compare 55713 office and facility rates across CMS payment localities in Kansas.
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 55713 in Kansas?
Kansas 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
$696.99
1 of 1 localities have a supported rate.
Payment area: Kansas
One mapped payment locality.
Facility setting
$174.03
1 of 1 localities have a supported rate.
Payment area: Kansas
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 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 Kansas, from the same CMS release.
$553.09
Use 55712 for a transperineal biopsy guided by MRI-ultrasound fusion. This code describes direct in-bore CT or MRI guidance instead.
$74.87
55715 is the add-on for each additional lesion in the applicable guidance family; this code reports the first lesion.
$312.95
55707 describes transrectal ultrasound-guided needle biopsy, not direct in-bore CT or MRI targeting.
Compare 55713 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
Kansas →
Office / nonfacility
$696.99
Facility
$174.03
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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 Kansas.
PPRRVU2026_Oct_nonQPP.csv
6,369
- Code
- 55713
- Physician work
- 4.00
- Practice expense
- 18.38
- Malpractice
- 0.50
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.00 | × 1.000 | 4.0000 |
| Practice expense | 18.38 | × 0.904 | 16.6155 |
| Malpractice | 0.50 | × 0.504 | 0.2520 |
| Total RVUs | 20.8675 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kansas$696.99
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4 | 1 |
| Practice expense | 18.38 | 0.904 |
| Malpractice | 0.5 | 0.504 |
(4 × 1 + 18.38 × 0.904 + 0.5 × 0.504) × $33.4009 = $696.99
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4 | 1 |
| Practice expense | 1.06 | 0.904 |
| Malpractice | 0.5 | 0.504 |
(4 × 1 + 1.06 × 0.904 + 0.5 × 0.504) × $33.4009 = $174.03
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.
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.
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
6,37255720,,Drainage of prostate abscess,A,,7.54,3.91,NA,3.91,,0.98,12.43,12.43,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958