$314.12
Choose 55709 when the biopsy needle enters through the perineum. Choose 55707 when the needle passes through the rectal wall under ultrasound guidance.
On this page
CMS RVU26D · Effective 2026-10-01
55709 Prostate biopsy Medicare reimbursement rates in Kentucky
Report this service for prostate tissue sampling through the perineum when ultrasound guides needle placement and MRI fusion is not used. Compare 55709 office and facility rates across CMS payment localities in Kentucky.
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 55709 in Kentucky?
Kentucky 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
$529.60
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$157.24
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 55709: Transperineal ultrasound-guided prostate biopsy
Report this service for prostate tissue sampling through the perineum when ultrasound guides needle placement and MRI fusion is not used.
A urologist typically performs this biopsy by passing a needle through the skin between the scrotum and anus into the prostate, using ultrasound to guide sampling. It may be performed in an office procedure room or a facility. The transperineal route accesses prostate tissue without passing the needle through the rectal wall; ultrasound guides the biopsy rather than MRI-ultrasound fusion.
Documentation should support the transperineal route, ultrasound guidance, the biopsy performed, and the clinical indication. This code represents the biopsy service, not a separate charge for each tissue core. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery is payable only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 55709
- 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 RVU3.23 · 19%
- Practice expense (office) RVU13.77 · 79%
- Malpractice RVU0.42 · 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.
55709 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$594.45
55710 is the transperineal ultrasound-guided biopsy variant that uses MRI fusion; 55709 describes ultrasound guidance without MRI fusion.
$214.43
55705 covers prostate biopsy without imaging guidance. Use 55709 when ultrasound guides needle placement through the perineal route.
No office rate
55706 identifies needle saturation sampling. 55709 is selected for transperineal ultrasound-guided biopsy rather than on the basis of saturation sampling.
Compare 55709 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
Kentucky →
Office / nonfacility
$529.60
Facility
$157.24
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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 55709 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
6,365
- Code
- 55709
- Physician work
- 3.23
- Practice expense
- 13.77
- Malpractice
- 0.42
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.23 | × 1.000 | 3.2300 |
| Practice expense | 13.77 | × 0.889 | 12.2415 |
| Malpractice | 0.42 | × 0.915 | 0.3843 |
| Total RVUs | 15.8558 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$529.60
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.23 | 1 |
| Practice expense | 13.77 | 0.889 |
| Malpractice | 0.42 | 0.915 |
(3.23 × 1 + 13.77 × 0.889 + 0.42 × 0.915) × $33.4009 = $529.60
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.23 | 1 |
| Practice expense | 1.23 | 0.889 |
| Malpractice | 0.42 | 0.915 |
(3.23 × 1 + 1.23 × 0.889 + 0.42 × 0.915) × $33.4009 = $157.24
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.
55709 billing questions
How does this differ from 55707?
55709 is for biopsy through the perineum with ultrasound guidance. 55707 describes the transrectal ultrasound-guided approach.
Should this be reported once per biopsy core?
No. Report the biopsy service, not a separate unit for each tissue core.
Can modifier 50 be used for sampling both sides of the prostate?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 is not used.
Does MRI-ultrasound fusion change the code?
Yes. 55709 is for ultrasound-guided transperineal biopsy without MRI fusion; 55710 identifies the transperineal MRI-fusion service.
When is an assistant at surgery payable?
Only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this code.
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.
6,36255706,,Bx prst8 ndl sat sampling,A,,4.16,1.40,NA,1.40,,0.53,6.09,6.09,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,36355707,,Bx prst8 trct us guided,A,,2.63,7.26,,1.10,,0.35,10.24,4.08,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,36455708,,Bx prst8 trct us w/mri fus 1,A,,3.39,8.74,,1.26,,0.43,12.56,5.08,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,36555709,,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
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
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631